HomeMy WebLinkAboutPR16-104CITY OF DIAN40ND BAR
DEPARTMENT OF COMNfUNI'PY it-DDEVELOPMENT SERVICES
w 21810 Copley Drive, Diamond Bar, -CA 91765 fD
(909) 839-7020 Fax (909) 861-3117 Building Inspection Hotline (909) 839-7027 PRESS
BUILDING PERMIT APPLICATION FIRMLY
JOBSITE • V
ADDRESS
APN LOT TRACT
OWNER UKdA
ADD SS
CITY z10 q1V fELLW' 2N1A JL 0
APPLICANT TEL.
A It
CONTRACTV9
ADDR S 117 l� '
CITY ZIP 1 0 TEL.U'14041Z.
ARCH/ENG/
DESIGNER
ADDRESS
CITY ZIP TEL.
OWNER -BUILDER DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI-
CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE: ANY CITY OR
COUNTY WHICH REQUIRES A PERMITTO CONSTRUCT, ALTER, IMPROVE, DEMOLISH, OR REPAIR ANY STRUG
TUBE, PRIOR TO ITS ISSUANCE, ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI-
CENSE LAW (CHAPTER D (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PRO.
FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP-
TION. ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO
A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (5500).):
❑ I, AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION,
WILL DO THE WORK AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044. BUSI-
NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF
PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR
OFFERED FOR SALE IF, HOWEVER THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE-
TION, THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
IMPROVE FOR THE PURPOSE OF SALE).
❑ I, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS
TO CONSTRUCT THE PROJECT (SEC. 7044. BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI-
CENSE LAW DOES NOT APPLY TO AN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THEREON, AND
WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC-
TORS LICENSE LAW.).
❑ 1 AM EXEMPT UNDER SEC. B. d P.C. FOR THIS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER
8 (COMMENCING WITH SECTION 7000) OF DIVISION 3 O THE BUSINESS AND PROFESSIONS CODE, AND
MY LICENSE IS IN FULLFO C''E77A//NyyD EFFECT.
LICENSE LAS �/J1J LIC. NO. _
DATE b CO
NTRACT0
WORKERS' COMPENSATION DECLARTION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS:
I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS•
COMPENSATION, AS PROVIDED BY SECTION 37DD OF THE LABOR CODE, FOR THE PERFORMANCE
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.
I HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE. AS REQUIRED BY SECTION
3700 OF THE LABOR CODE. OR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUEO. MY ERS' COI P 1SATION INSURANCE CARRIER AND POLICY NUMBER ARE:
CARRIER
POLICY NUMBER
(THIS SECTION NEED NOT BE CAAFLETED OF THE PERMIT IS FORONE HUM1DRED DOLLARS (5100)OR LESS}
I CERTIFY THAT IN THE PERFORMANCE OF WORK FOR WHICH IS PERMIT IS ISSUED, I
SHALL NOT EMPLOY ANY PERSON IN ANY AN R SO AS TO BE E SUBJE T THE
WORKERS' COMPENSATION LAWS OFC IFOR A AND AGREE A IF ISH BECOME
S EJECT T THE WORKERS' COMPENS ION P OVISIONS OF S ON 37 THE LABOR
1 DE, I S LL FORTHWITH COMPLY W T.
p NS.
DATE: • APPLICA T.
WARNING: FAILURE O SECURE WORKERS' PENSATION COVERAGE IS UtAWFUaND SHALL BE
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ON HUNDRED THOUSAND
DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3708 OF THE LABOR CODE. INTEREST, AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS ACONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3087, CIV. C.).
LENDERS NAME
LENDERS ADDRESS
'I CERTIFY THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT.
1 AGREE TO COMPLY WITH ALL CRY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING
CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE
ABO E -MENTIONED PRO ERTY FOR I PECTION PURPOSES.
v� a i rl L
PE E N E ( INT) I
SI RE OF PERMITTEE DIfE
APPLICATIO�1 PERMIT p(R
P/C
DATE / \q - \ NUMBER llo
ISSUE TYPE
`�\
OCC
DATE �4- I 1 b CONST.
GROUP
ZONING SETBACKS
FRONT
RW
❑
REAR
❑
SIDE/SIDE STREET
RW
❑
SIDE
❑
�U-
PROPOSED USE
IN
NO. DWEL. NO.
NO.
UNITS STORIES
BEDROOMS
DESCRIPTION SO. FT.
FACTOR PSF
ADJ. AREA/VALUATION
SFR/ADD/REM
U)
Garage/Carport
WPatio/Dock
V-
Pool/Spa
0
Z
Re -Roof
Commercial
m
Valuation
ADJ.AREA
QUANTITY DESCRIPTION
FEE
J
Q
'
U
tr
It
F
_P
U
W
CnO
I
W
.
0
Z
MIS
Ineu
m
a
FV-4"AAU
40.Q00 6
U
a
0 SZoom
8
7V
U
i... o twtb
co
W
CONSTRUCTION.
PLAN. REVIEW
ELECTRIC
.PLUMBING
MECHANICAL
G
9R 40
.. 40 a•
INSPECTION FEE
ISSUANCE
SMIP
ENERGY P/C
ENERGY PERMIT
RETENTION FEE:
b0
PRE -ALT FEE:
TOTAL FEES
13a, a4,
COMMENTS
RECPT NO. a °J �-� PAID BY A"St—
VALIDATION_
I WWE—Department Copy, YELLOW—Finance Copy, PINK—Assessor Copy, GOLDENROD—File Copy, GREEN—Applicant's Copy
CITY OF Dii�Wf6N" D'BAR
INSPECTION RECORD
•
SET BACK
b
e ® e '� s
o
®
FLOORJOIST
FHA REQMTS
UNDER FLOOR DUCT
FTGS/ FORMS/STEEL
ELECTRIC GROUND
GROUND PLUMBING
UNDER FLOOR CONDUIT
SLAB GRADE
FIREPLACE FOUNDATION
TEMP POWER
FIREPLACE BOND BEAM
WATER SERVICE
MID HT. BOND BEAM
ROOF SHEATHING
18 FT. BOND BEAM
FRAMING/VENTILATION
ROOF COVER
ROUGH HEATING
j FINAL BOND BEAM
PRE -GRADING
BENCHING
—_ _--_
_--_--
—
_
ROUGH ELECTRIC
_ _ _ _ _
-- ---
ROUGH GRADING
_
ROUGH PLUMBING
' FINISH GRADING
SHOWER/TUBTEST
POOL ELECTRIC
EXT. LATH/SIDING
POOL FENCING
WALL INSULATION
POOL FINAL
CEILING INSULATION
OFF SITE IMPS.
NAILING
DEDICATIONS—
_DRYWALL
SEWER
_ _ — –
FINAL ENG.
_
SEPTICTANK
_
LANDSCAPE/IRRIG.
SEEP PIT/L.L.
_ _
ON SITE IMPS.
GAS AIR TEST
„ q c r „ , ,.,
FINAL ZONING
FINAL CONST.
–' •. s';
FIRE DEPT. FINAL
FINAL HEATING
:'IN f_ ..�
HEALTH DEPT. FINAL
FINAL ELECTRIC
" ` ".
DEV. FEES PAID
FINAL PLUMBING
ENERGY
FINAL PLANING
FINAL ENGINEERING
® e
COMMENTS
_
SEPTIC TANK SIZE
SEEP PIT/U SIZE
—
CERTIFICATE OF INSTALLATION
CF2R-MCH-01-E
Space Conditioning Systems, Ducts, and Fans
(Page 1 of 8 )
Project Name: Kim Residence
Enforcement Agency: City of Diamond Bar
Permit Number:
PR2016-104
Dwelling Address: 21333 Chirping Sparrow Rd
City: Diamond Bar
Zip Code:
91765
A. General Information
01
Dwelling Unit Name
Kim Residence
02
Climate Zone
9
03
Dwelling Unit Total Conditioned Floor
2037
04
Number of Space Conditioning
1
CFA served
Area (ft2)
Installing a
Installing new SC
Systems in this Dwelling Unit.
Installing
05
Certificate of Compliance Type
Prescriptive alterations (CF1R-ALT)
06
Method used to Calculate HVAC Loads
ACCA_ManualJ
07
Calculated Dwelling Unit Sensible
34571
08
Calculated Dwelling Unit Heating Load
44738
Name
Cooling Load (Btuh)
System (ft2)ducted
(Btuh)
components?
10-9
Dwelling Unit Number of Bedrooms
4
MCH -01b Prescriptive Alterations - Space Conditioning Systems Ducts and Fans
B. Space Conditioning (SC) System Information
01
02
03
04
05
06
07
08
09
10
SC System
SC System
CFA served
Is the SC
Installing a
Installing new SC
Installing more
Installing
Installing
Identification or
Location or Area
by this SC
a
systemsystem
refrigerant
-
than 40 feet of
entirely new
entirely new SC
Alteration Type
Name
Served
System (ft2)ducted
containing
components?
ducts?
duct system?
system?
system.
component.
Entirely new or
complete
System 1
Location 1
2037
Yes
Yes
Yes
Yes
Yes
Yes
replacement space
conditioning
system
Registration Number: 216-A0084427A-M0100002A-0000
CA Building Energy Efficiency Standards - 2013 Residential Compliance
Registration Date/Time: 2016-03-30 10:03:56
Report Version: 2013 Rev 1.007
Schema Version: 2013.1.007
HERS Provider: CaICERTS
Report Generated: 2016-03-28 16:55:37
c
CERTIFICATE OF INSTALLATION CF2R-MCH-01-E
Space Conditioning Systems, Ducts, and Fans (Page 2 of 8 )
C. Space Conditioning (SC) System Alterations Compliance Information
01
02
03
04
05
06
07
08
09
10
11
12
13
Heating Efficiency Type
Heating Efficiency
Value
Heating Unit
Manufacturer
Heating Unit
Model Number
Heating Unit serial
number
Rated Heating Capacity,
Output (BTUH)
System 1
AFUE
0.8
Trane
TUD2C080ACV42
14272N11 -1G
Central Fan
Notes:
Condenser Rated
System Identification
Cooling Efficiency
Cooling Efficiency
Package Unit
Package Unit
Package Unit
Capacity at Design
Nominal Capacity
or Name
Type
Integrated
Manufacturer
Model Number
Serial Number
Conditions (BTUH)
Heating
System 1
SEER
16
Cooling
4TTR70048A100
New or
48000
(CFI)
System
Altered
Heating
Minimum
Altered
Cooling
Minimum
Required
Replaced
New
Ventilation
Identification
Heating
Heating
Efficiency
Efficiency
Cooling
Cooling
Efficiency
Efficiency
Thermostat
Duct
Duct
System
or Name
System Type
Component
Type
Value
System Type
Components
Type
Value
Type
Length
R -Value
Status
All new
All new
System 1
Central gas
heating
AFUE
0.78
Central
cooling
SEER
13
Setback
GT40Ft
R6
Not a CFI
furnace
componen
split AC
components
system
is
D. Installed Heating Equipment Information
01
02
03
04
05
06
07
System Identification or
Name
Heating Efficiency Type
Heating Efficiency
Value
Heating Unit
Manufacturer
Heating Unit
Model Number
Heating Unit serial
number
Rated Heating Capacity,
Output (BTUH)
System 1
AFUE
0.8
Trane
TUD2C080ACV42
14272N11 -1G
64000
Notes:
Condenser Rated
System Identification
Cooling Efficiency
Cooling Efficiency
Package Unit
E. Installed Cooling Equipment information
01
02
03
04
05
06
07
08
Condenser or Package Unit
Condenser or
Condenser or
Condenser or
System Rated Cooling
Condenser Rated
System Identification
Cooling Efficiency
Cooling Efficiency
Package Unit
Package Unit
Package Unit
Capacity at Design
Nominal Capacity
or Name
Type
Value
Manufacturer
Model Number
Serial Number
Conditions (BTUH)
(ton)
System 1
SEER
16
Trane
4TTR70048A100
15211YGT2F
48000
4
Registration Number: 216-A0084427A-M0100002A-0000
Registration Date/Time: 2016-03-30 10:03:56
HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-03-28 16:55:37
Schema Version: 2013.1.007
CERTIFICATE OF INSTALLATION CF2R-MCH-01-E
Space Conditioning Systems, Ducts, and Fans (Page 3 of 8 )
E. Installed Cooling Equipment information
01 02 03
04 05 06
07 08
04
Condenser or Package Unit
06
System Identification
or Name
Cooling Efficiency
Type
Cooling Efficiency
Value
Condenser or
Package Unit
Manufacturer
Condenser or
Package Unit
Model Number
Condenser or
Package Unit
Serial Number
System Rated Cooling
Capacity at Design
Conditions (BTUH)
Condenser Rated
Nominal Capacity
(ton)
Notes:
F. Extension of Existing Duct System, Greater Than 40 Feet
This section does not apply to this project.
G. Installed Duct System information
01
02
03
04
05
06
07
08
09
Method of
Can RA3.3
compliance with
Airflow
SC System
SC System
duct and filter
Number of Air
Protocols be
Identification or
Location or Area
Supply Duct
Supply Duct
Return Duct
Return Duct
grille sizing Req's
Filter Devices on
used to test
Name
Served
Location
R -Value
Location
R -Value
in 150.0(m)13
System
this system?
HERS verified fan
Conditioned
Conditioned
efficacy (W/cfm)
1
Yes
System 1
Location 1
space -entirely
R-8
space -entirely
R-6
and airflow rate
(cfm/ton)
Notes:
Registration Number: 216-A0084427A-M0100002A-0000
Registration Date/Time: 2016-03-30 10:03:56
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-03-28 16:55:37
Schema Version: 2013.1.007
CERTIFICATE OF INSTALLATION CF2R-MCH-01-E
Space Conditioning Systems, Ducts, and Fans (Page 4 of 8 )
H. Installed Air Filter Device Information
01
02
03
04
05
06
07
allowable clean -filter pressure drop at the design airflow rate applicable to each air filter device shall be determined, and all system air filter device locations shall be
02
labeled to disclose the applicable design airflow rate and the maximum allowable clean -filter pressure drop. The labels shall be permanently affixed to the air filter
device, readily legible, and visible to a person replacing the air filter media, and the air filter devices shall be provided with air filter media that conforms to these
Determined Design
03
All system air filter devices shall be located and installed in such a manner as to allow access and regular service by the system owner.
The system shall be provided with air filter media having a designated efficiency equal to or greater than MERV 6 when tested in accordance with ASHRAE Standard
04
Determined Design
Allowable Pressure
SC System Identification or
SC System Location or
Air Filter Identification
Air Filter Device
Air Filter Device
Airflow Rate for Air
Drop for Air Filter
Name
Area Served
or Name
Type
Location
Filter Device (cfm)
Device (inch W.C.)
System 1
Location 1
Glas Flos
Furnace
Mounted
Hallway
1600
0.12
Notes:
I. Air Filter Device Requirements
The system shall be designed to ensure that all recirculated air and all outdoor air supplied to the occupiable space is filtered before passing through the system's
01
thermal conditioning components.
The system shall be designed to accommodate the clean -filter pressure drop imposed by the system air filter device(s). The design airflow rate and maximum
allowable clean -filter pressure drop at the design airflow rate applicable to each air filter device shall be determined, and all system air filter device locations shall be
02
labeled to disclose the applicable design airflow rate and the maximum allowable clean -filter pressure drop. The labels shall be permanently affixed to the air filter
device, readily legible, and visible to a person replacing the air filter media, and the air filter devices shall be provided with air filter media that conforms to these
determined or labeled maximum allowable clean -filter pressure drop values as rated using AHRI Standard 680.
03
All system air filter devices shall be located and installed in such a manner as to allow access and regular service by the system owner.
The system shall be provided with air filter media having a designated efficiency equal to or greater than MERV 6 when tested in accordance with ASHRAE Standard
04
52.2, or a particle size efficiency rating equal to or greater than 50 percent in the 3.0 to10 micron range when tested in accordance with AHRI Standard 680.
The system shall be provided with air filter media that has been labeled by the manufacturer to disclose the efficiency and pressure drop ratings that conform to the
05
required efficiency and pressure drop requirements for the air filter device.
The responsible persons signature on this compliance document affirms that all applicable requirements in this table have been met.
Registration Number: 216-A0084427A-M0100002A-0000
Registration Date/Time: 2016-03-30 10:03:56
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-03-28 16:55:37
Schema Version: 2013.1.007
CERTIFICATE OF INSTALLATION CF2R-MCH-01-E
Space Conditioning Systems, Ducts, and Fans (Page 5 of 8 )
J. HERS Verification Requirements
01
02
03
04
0S
06
07
08
09
10
MCH20
MCH21
MCH22
MCH23
MCH25
MCH28
Exemption
from
Minimum
Exemption
R -Value for
AHU
System
SC System
From Duct
Duct
Ducts In
Ducts Located
AHU Fan
Airflow
Identification or
Location or Area
Leakage
Leakage
Conditioned
In Cond Space
Efficacy
Rate
Refrigerant
Return Duct Design
Name
Served
Requirements
Test
Space
Verification
(W/cfm)
(cfm/ton)
Charge
Table 150.0-C or D
System 1
Location 1
No
Yes
No
No
Yes
Yes
Yes
No
exemptions
Exemption
Notes:
Registration Number: 216-A0084427A-M0100002A-0000
Registration Date/Time: 2016-03-30 10:03:56
HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-03-28 16:55:37
Schema Version: 2013.1.007
CERTIFICATE OF INSTALLATION CF2R-MCH-01-E
Space Conditioning Systems, Ducts, and Fans (Page 6 of 8 )
K. Space Conditioning Systems, Ducts and Fans Mandatory Requirements and Additional Measures
Note: Additional mandatory requirements from Section 150.0 that are not listed here may be applicable to some systems. These requirements may be applicable to only newly installed equipment or portions of the
system that are altered. Existing equipment may be exempt from these requirements.
Heating Equipment
Equipment Efficiency: All heating equipment must meet the minimum efficiency requirements of Section 110.1 and Section 110.2(a) and the Appliance Efficiency
01
Regulations.
Controls: All unitary heating systems, including heat pumps, must be controlled by a setback thermostat. These thermostats must be capable of allowing the occupant
02
to program the temperature set points for at least four different periods in 24 hours. See Sections 150.0(i), 110.2(b).
Sizing: Heating load calculations must be done on portions of the building served by new heating systems to prevent inadvertent undersizing or oversizing. See sections
03
150.0(h)1 and 2).
Furnace Temperature Rise: Central forced -air heating furnace installations must be configured to operate at or below the furnace manufacturer's maximum
04
inlet -to -outlet temperature rise specification. See Section 150.0(h)4.
05
Standby Losses and Pilot Lights: Fan -type central furnaces may not have a continuously burning pilot light. Section 110.5 and Section 110.2(d).
Cooling Equipment
Equipment Efficiency: All cooling equipment must meet the minimum efficiency requirements of Section 110.1 and Section 110.2(a) and the Appliance Efficiency
06
Regulations.
Refrigerant Line Insulation: All refrigerant line insulation in split system air conditioners and heat pumps must meet the R -value and protection requirements of Section
07
150.0(j)2 and 3, and Section 150.0(m)9.
O8
Condensing Unit Location: Condensing units shall not be placed within five (5) feet of a dryer vent outlet. See Section 150.0(h)3A.
Sizing: Cooling load calculations must be done on portions of the building served by new cooling systems to prevent inadvertent undersizing or oversizing. See Section
09
150.0(h)1 and 2.
Air Distribution System Ducts, Plenums and Fans
Insulation: In all cases, unless ducts are enclosed entirely in directly conditioned space, the minimum duct insulation value is R-6. Note that higher values may be
10
required by the prescriptive or performance requirements. See Section 150.0(m)1.
Registration Number: 216-A0084427A-M0100002A-0000
Registration Date/Time: 2016-03-30 10:03:56
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-03-28 16:55:37
Schema Version: 2013.1.007
CERTIFICATE OF INSTALLATION CF2R-MCH-01-E
Space Conditioning Systems, Ducts, and Fans (Page 7 of 8 )
K. Space Conditioning Systems, Ducts and Fans Mandatory Requirements and Additional Measures
Note: Additional mandatory requirements from Section 150.0 that are not listed here may be applicable to some systems. These requirements may be applicable to only newly installed equipment or portions of the
system that are altered. Existing equipment may be exempt from these requirements.
11
Connections and Closures: All installed air -distribution system ducts and plenums must be, sealed and insulated to meet the requirements of CMC Sections 601.0,
602.0, 603.0, 604.0, 605.0 and ANSI/SMACNA-006-2006: Supply -air and return -air ducts and plenums must be insulated to a minimum installed level of R-6.0 or
enclosed entirely in directly conditioned space as confirmed through field verification and diagnostic testing in accordance with the requirements of Reference
Residential Appendix RA3.1.4.3.8.
Heat Pump Thermostat
12
A thermostat shall be installed that meets the requirements of Section 110.2(b) and Section 110.2(c).
13
The thermostat shall be installed in accordance with the manufacturers published installation specifications
14
First stage of heating shall be assigned to heat pump heating.
15
Second stage back up heating shall be set to come on only when the indoor set temperature cannot be met.
The responsible person signature on this compliance document affirms that all applicable requirements in this table have been met.
Registration Number: 216-A0084427A-M0100002A-0000
Registration Date/Time: 2016-03-30 10:03:56
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-03-28 16:55:37
Schema Version: 2013.1.007
CERTIFICATE OF INSTALLATION CF2R-MCH-01-E
Space Conditioning Systems, Ducts, and Fans (Page 8 of 8 )
Documentation Author's Declaration Statement
1. 1 certify that this Certificate of Installation documentation is accurate and complete.
Documentation Author Name:
Documentation Author Signature:
Ramirez, Connie
Company:
Signature Date:
COMFORT CLIMATE CONTROL INC
2016-03-30 10:03:56
Address:
CEA/ HERS Certification Identification (if applicable):
P 0 BOX 215
City/State/Zip:
Phone:
AZUSA CA 91702
1626-815-1632
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 Installation is true and correct.
2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction, or installation of features, materials,
components, or manufactured devices for the scope of work identified on this Certificate of Installation, and attest to the declarations in this statement (responsible builder/installer), otherwise I am an
authorized representative of the responsible builder/installer.
3. The constructed or installed features, materials, components or manufactured devices (the installation) identified on this Certificate of Installation conforms to all applicable codes and regulations, and the
installation conforms to the requirements given on the plans and specifications approved by the enforcement agency.
4. 1 reviewed a copy of the Certificate of Compliance approved by the enforcement agency that identifies the specific requirements for the scope of construction or installation identified on this Certificate of
Installation, and I have ensured that the requirements that apply to the construction or installation have been met.
5. 1 will ensure that a registered copy of this Certificate of Installation shall be 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 Installation is required to be included with the documentation the builder provides to the building owner at occupancy.
Responsible Builder/Installer Name:
Responsible Builder/Installer Signature:
Ramirez, Connie
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
Position With Company (Title):
COMFORT CLIMATE CONTROL INC
Owner
Address:
CSLB License:
P 0 BOX 215
1641060
City/State/Zip:
Phone:
Date Signed:
AZUSA CA 91702
1626-815-1632
12016-03-30 10:03:56
Digitally signed by Ca10ERTS. 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: 216-A0084427A-M0100002A-0000 Registration Date/Time: 2016-03-30 10:03:56 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013 Rev 1.007 Report Generated: 2016-03-28 16:55:37
Schema Version: 2013.1.007
CERTIFICATE OF INSTALLATION
CF2R-MCH-20-H
Duct Leakage Diagnostic Test
(Page 1 of 3 )
Project Name: Kim Residence
Enforcement Agency: City of
Diamond Bar
Permit Number:
PR2016-104
Dwelling Address: 21333 Chirping Sparrow Rd
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
Location 1
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
Replacement
MCH -20d - Complete Replacement or Altered Duct System
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)
2037
04
Duct Leakage Test Condition
Test final
05
Duct Leakage Test Method
Total leakage
06
Leakage Factor
0.06
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 (cfm)
96
10
Actual duct leakage rate from leakage test measurement
(cfm)
91
11
Compliance Statement
System passes leakage test
Registration Number: 216-A0084427A-M2000002A-0000 Registration Date/Time: 2016-03-30 10:03:56 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-03-28 16:56:18
2013 Residential Compliance Schema Version: 2013.1.007
CERTIFICATE OF INSTALLATION CFZR-MCH-20-H
Duct Leakage Diagnostic Test (Page 2 of 3 )
C. Additional Requirements for Compliance
01
System was tested in its normal operation condition. No temporary taping allowed.
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
02
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
If a complete replacement, 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.
If the system complies using the Smoke Test method, the smoke test was conducted in accordance with the requirements
07
of Reference Residential Appendix RA3.1.4.3.6. Systems that comply using smoke test shall not be included in sample
groups for HERS verification compliance.
The responsible persons signature on this compliance document affirms that all applicable requirements in this table have
been met.
Registration Number: 216-A0084427A-M2000002A-0000 Registration Date/Time: 2016-03-30 10:03:56 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-03-28 16:56:18
2013 Residential Compliance Schema Version: 2013.1.007
CERTIFICATE OF INSTALLATION CF2R-MCH-20-H
Duct Leakage Diagnostic Test (Page 3 of 3 )
Documentation Author's Declaration Statement
1. 1 certify that this Certificate of Installation documentation is accurate and complete.
Documentation Author Name:
Documentation Author Signature:
Connie Ramirez
Company:
Signature Date: 2016-03-30 10:03:56
COMFORT CLIMATE CONTROL INC
Address:
CEA/ HERS Certification Identification (if applicable):
P 0 BOX 215
City/State/Zip:
Phone:
AZUSA CA 91702
626-815-1632
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 Installation is true and correct.
2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design,
construction, or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of
Installation and attest to the declarations in this statement (responsible builder/installer), otherwise I am an authorized representative of the
responsible builder/installer.
3. The constructed or installed features, materials, components or manufactured devices (the installation) identified on this Certificate of Installation
conforms to all applicable codes and regulations, and the installation conforms to the requirements given on the plans and specifications approved by
the enforcement agency.
4. 1 understand that a HERS rater will check the installation to verify compliance, and that if such checking identifies defects; I am required to take
corrective action at my expense. I understand that Energy Commission and HERS Provider representatives will also perform quality assurance checking
of installations, including those approved as part of a sample group but not checked by a HERS rater, and if those installations fail to meet the
requirements of such quality assurance checking, the required corrective action and additional checking/testing of other installations in that HERS
sample group will be performed at my expense.
5. 1 reviewed a copy of the Certificate of Compliance approved by the enforcement agency that identifies the specific requirements for the scope of
construction or installation identified on this Certificate of Installation, and I have ensured that the requirements that apply to the construction or
installation have been met.
6. 1 will ensure that a registered copy of this Certificate of Installation shall be 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
Installation is required to be included with the documentation the builder provides to the building owner at occupancy.
Responsible Builder/Installer Name:
Responsible Builder/Installer Signature:
Connie Ramirez
Company Name: (Installing Subcontractor or General Contractor or
Position With Company (Title):
Builder/Owner)
Owner
COMFORT CLIMATE CONTROL INC
Address:
CSLB License:
P O BOX 215
641060
City/State/Zip:
Phone:
Date Signed:
AZUSA CA 91702
626-815-1632
2016-03-30 10:03:56
Third Party Quality Control Program (TPQCP) Status:
Name of TPQCP (if applicable):
Digitally signed by Ca10ERTS. 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: 216-A0084427A-M2000002A-0000 Registration Date/Time: 2016-03-30 10:03:56 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-03-28 16:56:18
2013 Residential Compliance Schema Version: 2013.1.007
CERTIFICATE OF INSTALLATION
CF2R-MCH-23-H
Space Conditioning System Airflow Rate
(Page 1 of 3 )
Project Name: Kim Residence
Enforcement Agency: City of
Diamond Bar
Permit Number:
PR2016-104
Dwelling Address: 21333 Chirping Sparrow Rd
City: Diamond Bar
Zip Code:
91765
A. Ducted Cooling System Information
O1
System Identification or Name
System 1
02
System Location or Area Served
Location 1
03
System Installation Type
New
04
Nominal Cooling Capacity (tons) of Condenser
4
05
Condenser Speed Type
Multi -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
No Bypass Duct
09
Date of System Airflow Rate Measurement
2016-01-15
10
Airflow Rate Protocol utilized
RA3.3 procedures for 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.
O1 IMethod used to demonstrate compliance with theI 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
Powered Flow Capture Hood according to procedure in
verification.
RA3.3.3.1.3
02
Manufacturer of Airflow Measurement Apparatus
TSI
03
Model number of Airflow Measurement Apparatus
8371
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: 216-A0084427A-M2300002A-0000 Registration Date/Time: 2016-03-30 10:03:56 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-03-28 16:59:33
2013 Residential Compliance Schema Version: 0.555SDD
CERTIFICATE OF INSTALLATION CF211-MCH-23-1-11
Space Conditioning System Airflow Rate (Page 2 of 3 )
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/ton)
350
02
Required Minimum System Airflow Target (cfm)
1400
03
Actual System Airflow Rate Measurement (cfm)
1501
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 Installation.
The airflow rate measurement apparatus used to perform the airflow rate measurement identified on this Certificate of
02
Installation 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 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.
The responsible person's signature on this compliance document affirms that all applicable requirements in this table have
been met.
Registration Number: 216-A0084427A-M2300002A-0000 Registration Date/Time: 2016-03-30 10:03:56 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-03-28 16:59:33
2013 Residential Compliance Schema Version: 0.555SDD
CERTIFICATE OF INSTALLATION CF2R-MCH-23-H
Space Conditioning System Airflow Rate (Page 3 of 3 )
Documentation Author's Declaration Statement
1. 1 certify that this Certificate of Installation documentation is accurate and complete.
Documentation Author Name:
Documentation Author Signature:
Connie Ramirez
Company:
Signature Date: 2016-03-30 10:03:56
COMFORT CLIMATE CONTROL INC
Address:
CEA/ HERS Certification Identification (if applicable):
P O BOX 215
City/State/Zip:
Phone:
AZUSA CA 91702 1626-815-1632
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 Installation is true and correct.
2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design,
construction, or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of
Installation and attest to the declarations in this statement (responsible builder/installer), otherwise I am an authorized representative of the
responsible builder/installer.
3. The constructed or installed features, materials, components or manufactured devices (the installation) identified on this Certificate of Installation
conforms to all applicable codes and regulations, and the installation conforms to the requirements given on the plans and specifications approved by
the enforcement agency.
4. 1 understand that a HERS rater will check the installation to verify compliance, and that if such checking identifies defects; I am required to take
corrective action at my expense. I understand that Energy Commission and HERS Provider representatives will also perform quality assurance checking
of installations, including those approved as part of a sample group but not checked by a HERS rater, and if those installations fail to meet the
requirements of such quality assurance checking, the required corrective action and additional checking/testing of other installations in that HERS
sample group will be performed at my expense.
5. 1 reviewed a copy of the Certificate of Compliance approved by the enforcement agency that identifies the specific requirements for the scope of
construction or installation identified on this Certificate of Installation, and I have ensured that the requirements that apply to the construction or
installation have been met.
6. 1 will ensure that a registered copy of this Certificate of Installation shall be 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
Installation is required to be included with the documentation the builder provides to the building owner at occupancy.
Responsible Builder/Installer Name:
Responsible Builder/Installer Signature:
Connie Ramirez
Company Name: (Installing Subcontractor or General Contractor or
Position With Company (Title):
Builder/Owner)
Owner
COMFORT CLIMATE CONTROL INC
Address:
CSLB License:
P O BOX 215
641060
City/State/Zip:
Phone:
Date Signed:
AZUSA CA 91702
626-815-1632
2016-03-30 10:03:56
Third Party Quality Control Program (TPQCP) Status:
Name of TPQCP (if applicable):
Digitally signed by CaICERTS. 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: 216-A0084427A-M2300002A-0000 Registration Date/Time: 2016-03-30 10:03:56 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-03-28 16:59:33
2013 Residential Compliance Schema Version: 0.555SDD
CERTIFICATE OF INSTALLATION
CF211-MCH-22-11
Space Conditioning System Fan Efficacy
(Page 1 of 3 )
Project Name: Kim Residence
Enforcement Agency: City of
Diamond Bar
Permit Number:
PR2016-104
Dwelling Address: 21333 Chirping Sparrow Rd
City: Diamond Bar
Zip Code:
91765
A. Ducted Cooling System Information
01
System Identification or Name
System 1
02
System Location or Area Served
Location 1
03
System Installation Type
New
04
Nominal Cooling Capacity (tons) of Condenser
4
05
Condenser Speed Type
Multi -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
No Bypass Duct
09
Date of System Airflow Rate Measurement
2016-01-15
10
Airflow Rate Protocol utilized
RA3.3 procedures for airflow rate measurement
B. Fan Watt Measurement Apparatus and Procedure Information
Instrument Specifications are given in RA3.3.1, and system 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
451
02
Actual Tested Airflow from MCH -23 (cfm)
1501
03
Required Fan Efficacy (watts/cfm)
0.58
04
Actual Fan Efficacy (watts/cfm)
0.3
05
Compliance Statement:
System fan efficacy complies
Registration Number: 216-A0084427A-M2200002A-0000 Registration Date/Time: 2016-03-30 10:03:56 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-03-28 17:01:53
2013 Residential Compliance Schema Version: 0.52SDD
CERTIFICATE OF INSTALLATION CF2R-MCH-22-H
Space Conditioning System Fan Efficacy (Page 2 of 3 )
D. Additional Requirements
O1
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.
The responsible person's signature on this compliance document affirms that all applicable requirements in this table have
been met.
Registration Number: 216-A0084427A-M2200002A-0000 Registration Date/Time: 2016-03-30 10:03:56 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-03-28 17:01:53
2013 Residential Compliance Schema Version: 0.52SDD
CERTIFICATE OF INSTALLATION CF2R-MCH-22-H
Space Conditioning System Fan Efficacy (Page 3 of 3 )
Documentation Author's Declaration Statement
1. 1 certify that this Certificate of Installation documentation is accurate and complete.
Documentation Author Name:
Documentation Author Signature:
Connie Ramirez
Company:
Signature Date: 2016-03-30 10:03:56
COMFORT CLIMATE CONTROL INC
Address:
CEA/ HERS Certification Identification (if applicable):
P 0 BOX 215
City/State/Zip:
Phone:
AZUSA CA 91702 1626-815-1632
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 Installation is true and correct.
2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design,
construction, or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of
Installation and attest to the declarations in this statement (responsible builder/installer), otherwise I am an authorized representative of the
responsible builder/installer.
3. The constructed or installed features, materials, components or manufactured devices (the installation) identified on this Certificate of Installation
conforms to all applicable codes and regulations, and the installation conforms to the requirements given on the plans and specifications approved by
the enforcement agency.
4. 1 understand that a HERS rater will check the installation to verify compliance, and that if such checking identifies defects; I am required to take
corrective action at my expense. I understand that Energy Commission and HERS Provider representatives will also perform quality assurance checking
of installations, including those approved as part of a sample group but not checked by a HERS rater, and if those installations fail to meet the
requirements of such quality assurance checking, the required corrective action and additional checking/testing of other installations in that HERS
sample group will be performed at my expense.
5. 1 reviewed a copy of the Certificate of Compliance approved by the enforcement agency that identifies the specific requirements for the scope of
construction or installation identified on this Certificate of Installation, and I have ensured that the requirements that apply to the construction or
installation have been met.
6. 1 will ensure that a registered copy of this Certificate of Installation shall be 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
Installation is required to be included with the documentation the builder provides to the building owner at occupancy.
Responsible Builder/Installer Name:
Responsible Builder/Installer Signature:
Connie Ramirez
Company Name: (Installing Subcontractor or General Contractor or
Position With Company (Title):
Builder/Owner)
Owner
COMFORT CLIMATE CONTROL INC
Address:
CSLB License:
P 0 BOX 215
641060
City/State/Zip:
Phone:
Date Signed:
AZUSA CA 91702
626-815-1632
2016-03-30 10:03:56
Third Party Quality Control Program (TPQCP) Status:
Name of TPQCP (if applicable):
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: 216-A0084427A-M2200002A-0000 Registration Date/Time: 2016-03-30 10:03:56 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-03-28 17:01:53
2013 Residential Compliance Schema Version: 0.52SDD
CERTIFICATE OF INSTALLATION
CF2R-MCH-25-H
Refrigerant Charge Verification
(Page 1 of 4 )
Project Name: Kim Residence
Enforcement Agency: City of
Diamond Bar
Permit Number:
PR2016-104
Dwelling Address: 21333 Chirping Sparrow Rd
City: Diamond Bar
Zip Code:
91765
A. System Information
Each system requiring refrigerant charge verification will be documented on a separate certificate.
01
System Identification or Name
System 1
02
System Location or Area Served
Location 1
03
Condenser (or package unit) Make or Brand
Trane
04
Condenser (or package unit) Model Number
4TTR7048A1000
05
Nominal Cooling Capacity (tons) of Condenser
4
06
Condenser (or package unit) Serial Number
15211YGT2F
07
Refrigerant Type
R -410A
08
Other Refrigerant Type (if applicable)
09
System Installation Type
New
Charge Indicator Display (CID) Status (Note: Even systems
This system does not have a CID device installed
10
with a CID 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
11
verified using an approved measurement procedure (RA3.3
rate measurement procedures in RA3.3 or RA3.2.2.7 can be
or RA3.2.2.7)?
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 RA1 is applicable to this system and can be
12
with the refrigerant charge verification requirements when
used to verify compliance
temperatures are greater than or equal to 55F (RA3.2.2, or
RA1)?
13
Date of Refrigerant Charge Verification for this system
2016-01-15
14
Refrigerant charge verification method used.
Subcooling (outdoor temperature must be equal to or
greater than 55 degF)
Person who performed the Refrigerant Charge Verification
HVAC system installer
15
reported on this Certificate of Installation
16
HERS Verification Compliance Requirement Status
System qualifies for group sampling
MCH -25b - Refrigerant Charge Verification - Subcooling Method
Registration Number: 216-A0084427A-M2500002A-0000 Registration Date/Time: 2016-03-30 10:03:56 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-03-28 17:10:30
2013 Residential Compliance Schema Version: 2013.1.007
CERTIFICATE OF INSTALLATION CF2R-MCH-25-H
Refrigerant Charge Verification (Page 2 of 4 )
l
B. Metering Device Verification
Subcooling Method can only be used on systems that have a variable metering device.
01
Refrigerant metering device
Thermostatic Expansion Valve (TXV)
rO2Subcooling
Method applicability status
Subcooling Method is applicable to this system.
C. Instrument Calibration
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
2016-01-04
02
Date of Digital Thermocouple Calibration
2016-01-04
03
Digital Refrigerant Gauge Calibration Status
Calibration is current
04
Digital Thermocouple Calibration Status
Calibration is current
ID. Measurement Access Hole (MAH) Verification I
Procedures for installing MAH are specified in Reference Residential Appendix RA3.2.2.3
01 I Method used to demonstrate compliance with theI 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 RA3.2.2.7.
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
Procedures for determining Refrigerant Charge using the Standard Charge Verification Procedure are given in
Reference Residential Appendix RA3.2.2.
01
Lowest return air dry bulb temperature that occurred during
71
the refrigerant charge verification procedure (degreeF)
02
Measured Condenser air entering dry-bulb temperature (T
76
condenser, db)
03
Outdoor Temperature Qualification Status
Outdoor temperature is within range for using Subcooling
refrigerant charge verification method
04
Measured Liquid Line Temperature (Tuqud) (degreeF)
89
05
Measured Liquid Line Pressure (Pi qud) (pisg)
291
Registration Number: 216-A0084427A-M2500002A-0000 Registration Date/Time: 2016-03-30 10:03:56 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-03-28 17:10:30
2013 Residential Compliance Schema Version: 2013.1.007
CERTIFICATE OF INSTALLATION CF2R-MCH-25-H
Refrigerant Charge Verification (Page 3 of 4 )
F. Data Collection and Calculations
Procedures for determining Refrigerant Charge using the Standard Charge Verification Procedure are given in
Reference Residential Appendix RA3.2.2.
53
Condenser saturation temperature (Tcondensor, sat) from digital
97.5
06
gauge or P -T Table using Line F05 (degree F)
Evaporator saturation temperature (Tevaporator, sat) from
digital gauge or P -T Table using line G02 (degreeF)
07
Measured Subcooling
8.5
08
Target Subcooling
8
Passes CEC requirement
Compliance Statement: System complies with Subcooling Method - Must also pass metering device verification, next
09
section
G. Metering Device Verification
Procedures for the verification of proper metering device operation are specified in RA3.2.2.6.2
01
Measured Suction line temperature (Tsuction) (degreeF)
53
02
Measured Suction line pressure (Psuction) (psig)
117
03
Evaporator saturation temperature (Tevaporator, sat) from
digital gauge or P -T Table using line G02 (degreeF)
40
04
Measured Superheat
13
05
Measured Superheat is between 4 and 25 deg F (inclusive)
Passes CEC requirement
06
Measured Superheat is within manufacturer's specifications,
if known
Yes, documentation to be provided upon request
07
Compliance Statement: Metering device verification passes
Verification of Charge Indicator Display - CF2R-MCH-25d - CID
H. Charge Indicator Display
Procedures for the Charge Indicator Display Verification are detailed in RA3.4.2
This section does not apply to this project.
I. Charge Indicator Display - Additional Requirements
This section does not apply to this project.
Registration Number: 216-A0084427A-M2500002A-0000 Registration Date/Time: 2016-03-30 10:03:56 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-03-28 17:10:30
2013 Residential Compliance Schema Version: 2013.1.007
CERTIFICATE OF INSTALLATION CF2R-MCH-25-H
Refrigerant Charge Verification (Page 4 of 4 )
Documentation Author's Declaration Statement
1. 1 certify that this Certificate of Installation documentation is accurate and complete.
Documentation Author Name:
Documentation Author Signature:
Connie Ramirez
Company:
Signature Date: 2016-03-30 10:03:56
COMFORT CLIMATE CONTROL INC
Address:
CEA/ HERS Certification Identification (if applicable):
P O BOX 215
City/State/Zip:
1626-815-1632
Phone:
AZUSA CA 91702
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 Installation is true and correct.
2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design,
construction, or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of
Installation and attest to the declarations in this statement (responsible builder/installer), otherwise I am an authorized representative of the
responsible builder/installer.
3. The constructed or installed features, materials, components or manufactured devices (the installation) identified on this Certificate of Installation
conforms to all applicable codes and regulations, and the installation conforms to the requirements given on the plans and specifications approved by
the enforcement agency.
4. 1 understand that a HERS rater will check the installation to verify compliance, and that if such checking identifies defects; I am required to take
corrective action at my expense. I understand that Energy Commission and HERS Provider representatives will also perform quality assurance checking
of installations, including those approved as part of a sample group but not checked by a HERS rater, and if those installations fail to meet the
requirements of such quality assurance checking, the required corrective action and additional checking/testing of other installations in that HERS
sample group will be performed at my expense.
5. 1 reviewed a copy of the Certificate of Compliance approved by the enforcement agency that identifies the specific requirements for the scope of
construction or installation identified on this Certificate of Installation, and I have ensured that the requirements that apply to the construction or
installation have been met.
6. 1 will ensure that a registered copy of this Certificate of Installation shall be 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
Installation is required to be included with the documentation the builder provides to the building owner at occupancy.
Responsible Builder/Installer Name:
Responsible Builder/Installer Signature:
Connie Ramirez
Company Name: (Installing Subcontractor or General Contractor or
Position With Company (Title):
Builder/Owner)
Owner
COMFORT CLIMATE CONTROL INC
Address:
CSLB License:
P O BOX 215
641060
City/State/Zip:
Phone:
Date Signed:
AZUSA CA 91702
626-815-1632
2016-03-30 10:03:56
Third Party Quality Control Program (TPQCP) Status:
Name of TPQCP (if applicable):
Digitally signed by CaICERTS. 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: 216-A0084427A-M2500002A-0000 Registration Date/Time: 2016-03-30 10:03:56 HERS Provider: CalCERTS
CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-03-28 17:10:30
2013 Residential Compliance Schema Version: 2013.1.007
CERTIFICATE OF VERIFICATION CF3R-MCH-20-H
(Page 1 of 1)
Project Name: Kim Residence
Enforcement Agency: City of
Diamond Bar
Permit Number: PR2016-104
Dwelling Address: 21333 Chirping Sparrow Rd
City: Diamond Bar
Zip Code: 91765
HERS measure was verified using the methodology defined for the untested features included in a sample group.
This measure passes through its relationship with the actual one tested and passed. Therefore no data is included
on this Certificate of Verification.
Documentation Author's Declaration Statement
1. 1 certify that this Certificate of Verification documentation is accurate and complete.
Documentation Author Name:
Documentation Author Signature: ^
Stefanie N Forhan
Company: Maximum Performance Housing, Inc.
Date Signed:
Address:
CEA/ HERS Certification Identification (i app ica e):
224 Amherst Road
City/State/Zip: Costa Mesa CA 92626
Phone: 949-254-4114
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 Compliance 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 applicable sections of the Certificate(s) of Installation (CF2R) signed and submitted by the person(s) responsible for the
construction or installation conforms to the requirements specified on the Certificate(s) of Compliance (CF1R) approved by the enforcement agency.
5. 1 will ensure that a registered copy of this Certificate of Verification shall be 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 Contractor, or Builder/Owner): COMFORT CLIMATE CONTROL INC
Responsible Builder or Installer Name:
CSLB License:
Connie Ramirez
1641060
HERS Provider Data Registry Information
Sample Group Number (if applicable):
Dwelling Test Status in Sample Group (if applicable)
216-01418
Not tested
HERS Rater Information
HERS Rater company Name: Maximum Performance Housing, Inc.
Responsible Rater Name:
Responsible Rater Signature:
Jayme Carden
Responsible Rater Certification Number w/ this HERS Provider:
Date Signed:
CC2005489
2016-03-30 10:13:45
Digitally signed by CaICERTS. 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: 216-AO084427A-M2000002A-M20A Registration Date/Time: 2016-03-30 10:13:45 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-03-30 09:33:29
2013 Residential Compliance Schema Version: 0.52SDD
CERTIFICATE OF VERIFICATION CF3R-MCH-23-H
(Page 1 of 1)
Project Name: Kim Residence
Enforcement Agency: City of
Diamond Bar
Permit Number: PR2016-104
Dwelling Address: 21333 Chirping Sparrow Rd
City: Diamond Bar
Zip Code: 91765
HERS measure was verified using the methodology defined for the untested features included in a sample group.
This measure passes through its relationship with the actual one tested and passed. Therefore no data is included
on this Certificate of Verification.
Documentation Author's Declaration Statement
1. 1 certify that this Certificate of Verification documentation is accurate and complete.
Documentation Author Name:
Documentation Author Signature:
Stefanie N Forhan
Company: Maximum Performance Housing, Inc.
Date Signed:
-49-42
Address:
CEA/ HERS Certification Identification (i app ica e):
224 Amherst Road
City/State/Zip: Costa Mesa CA 92626
Phone: 949-254-4114
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 Compliance 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 applicable sections of the Certificate(s) of Installation (CF2R) signed and submitted by the person(s) responsible for the
construction or installation conforms to the requirements specified on the Certificate(s) of Compliance (CF1R) approved by the enforcement agency.
5. 1 will ensure that a registered copy of this Certificate of Verification shall be 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 Contractor, or Builder/Owner): COMFORT CLIMATE CONTROL INC
Responsible Builder or Installer Name:
CSLB License:
Connie Ramirez
1641060
HERS Provider Data Registry Information
Sample Group Number (if applicable):
Dwelling Test Status in Sample Group (if applicable)
216-01418
Not tested
HERS Rater Information
HERS Rater Company Name: Maximum Performance Housing, Inc.
Responsible Rater Name:
Responsible Rater Signature:
Jayme Carden
Responsible Rater Certification Number w/ this HERS Provider:
Date Signed:
CC2005489
2016-03-30 10:13:45
Digitally signed by CaICERTS. 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: 216-A0084427A-M2300002A-M23A Registration Date/Time: 2016-03-30 10:13:45 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-03-30 09:35:13
2013 Residential Compliance Schema Version: 0.52SDD
CERTIFICATE OF VERIFICATION CF3R-MCH-22-H
(Page 1 of 1)
Project Name: Kim Residence
Enforcement Agency: City of
Diamond Bar
Permit Number: PR2016-104
Dwelling Address: 21333 Chirping Sparrow Rd
City: Diamond Bar
Zip Code: 91765
HERS measure was verified using the methodology defined for the untested features included in a sample group.
This measure passes through its relationship with the actual one tested and passed. Therefore no data is included
on this Certificate of verification.
Documentation Author's Declaration Statement
1. 1 certify that this Certificate of Verification documentation is accurate and complete.
Documentation Author Name:
Documentation Author Signature:
Stefanie N Forhan
C�1/
Company: Maximum Performance Housing, Inc.
Date Signed:
Address:
CEA/ HERS Certification Identification (i appica e):
224 Amherst Road
City/State/Zip: Costa Mesa CA 92626
Phone: 949-254-4114
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 Compliance 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 applicable sections of the Certificate(s) of Installation (CF2R) signed and submitted by the person(s) responsible for the
construction or installation conforms to the requirements specified on the Certificate(s) of Compliance (CF1R) approved by the enforcement agency.
5. 1 will ensure that a registered copy of this Certificate of Verification shall be 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 Contractor, or Builder/Owner): COMFORT CLIMATE CONTROL INC
Responsible Builder or Installer Name:
CSLB License:
Connie Ramirez
1 641060
HERS Provider Data Registry Information
Sample Group Number (if applicable):
Dwelling Test Status in Sample Group (if applicable)
216-01418
Not tested
HERS Rater Information
HERS Rater Company Name: Maximum Performance Housing, Inc.
Responsible Rater Name:
Responsible Rater Signature:
Jayme Carden
Responsible Rater Certification Number w/ this HERS Provider:
Date Signed:
CC2005489
2016-03-30 10:13:46
Digitally signed by Ca10ERTS. 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: 216-A0084427A-M2200002A-M22A Registration Date/Time: 2016-03-30 10:13:46 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-03-30 09:36:39
2013 Residential Compliance Schema Version: 0.52SDD
CERTIFICATE OF VERIFICATION CF3R-MCH-25-H
(Page 1 of 1 )
Project Name: Kim Residence
Enforcement Agency: City of
Diamond Bar
Permit Number: PR2016-104
Dwelling Address: 21333 Chirping Sparrow Rd
City: Diamond Bar
Zip Code: 91765
HERS measure was verified using the methodology defined for the untested features included in a sample group.
This measure passes through its relationship with the actual one tested and passed. Therefore no data is included
on this Certificate of Verification.
Documentation Author's Declaration Statement
1.1 certify that this Certificate of Verification documentation is accurate and complete.
Documentation Author Name:
Documentation Author Signature:
Stefanie N Forhan
CC1/
Company: Maximum Performance Housing, Inc.
Date Signed:
Address:
CEA/ HERS Certification Identification (i appica e):
224 Amherst Road
City/State/Zip: Costa Mesa CA 92626
Phone: 949-254-4114
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 Compliance 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 applicable sections of the Certificate(s) of Installation (CF2R) signed and submitted by the person(s) responsible for the
construction or installation conforms to the requirements specified on the Certificate(s) of Compliance (CF1R) approved by the enforcement agency.
5. 1 will ensure that a registered copy of this Certificate of Verification shall be 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 Contractor, or Builder/Owner): COMFORT CLIMATE CONTROL INC
Responsible Builder or Installer Name:
CSLB License:
Connie Ramirez
1641060
HERS Provider Data Registry Information
Sample Group Number (if applicable):
Dwelling Test Status in Sample Group (if applicable)
216-01418
Not tested
HERS Rater Information
HERS Rater Company Name: Maximum Performance Housing, Inc.
Responsible Rater Name:
Responsible Rater Signature:
Jayme Carden
Responsible Rater Certification Number w/ this HERS Provider:
Date Signed:
CC2005489
2016-03-30 10:13:46
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: 216-A0084427A-M2500002A-M25A Registration Date/Time: 2016-03-30 10:13:46 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-03-30 09:41:39
2013 Residential Compliance Schema Version: 0.52SDD