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Home My WebLink About12-914 _��_ CITY OF DIAMOND BAR � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � � . T,w 21810 Copley Drive,Diamond Bar,CA 91765 � (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS ,�'^^'�. BUILDING PERMIT APPLICATION �' FIRMLY oJOBSITE ` 9,/ �p ADDRESS ��1� Blv� ��Im Lr DATE'CATIO lCl �Z NUMBER,��l//`�7'�y/C � ISSUE TyPE J—'F pCC � APN LOT TRACT DATE ' CONST.��ROUP p OWNER ��rV A�ics TOI�rr p ADDRESS 2.Z�oll� L3IvG. P0. m Lr. ZONING SEBACKS Z CITY �. , f.�t'ZIP 171au TEL.qU4-k'�,.�-�6 FRONT RW ❑ • o APPLICANT� � 3� ` TEI.c/SI-7J-�1-�7(o REAR p Z SIDE/SIDE STREET RW ❑ � CONTRACTOR� � �c� C 5 SIDE ❑ ADDRESS a ' � CITY �pY G.Z.i�r.d0.^ ,ZIp 9�2 � PROPOSED USE d�/� o � � �� TEL.�l y-777�T17 o ARCH/ENG/ z DESIGNER w NO.DWEL. NO. NO. a ADDRESS � CITY ZIP TEL. UNITS STORIES BEDROOMS � � DESCRIPTION S�.Ff. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILDER DECLARATION SFR/ADD/REM O p 1 HEHEBV AFFIRM UNDER PENALT/OF PERNRY THAT t AM E%EMVT fROM THE CONTRAC70RS ll- GdfeJB/CefP01f W CENSEUWFORTHEFOLLOWINOREASON(SEC.7031.SBUSINESSANDPROFESSIONSCOOE:ANYCITYOR � (n U CIXINTYWHICHREOUIRESAPERMITTOCONSTRUCT,ALTER�PROVE,DEAIOLISH,ORREVAIpANYSTRUG � � - w TURE.PRIOR TO RS ISSUANCE,ALSO REOUIpES THE APPLICANT f-0q SUCN PERMIT TO FILE A SIaNED W Patio/Deck � STATEMENT THA7 HE OR SHE IS LICENSED.PURSUANT TO hiE PROVISIONS OF THE COMMCTORS tJ- � .. . � CENSE UW(CHAPTER D(COMMENCING WI7H SECTION 7000)OF DIVISION J OF THE BUSINESS AND PRO- POOUSPe , 0 FESSIONSCOO�ORTHATHEORSHEISEXEMPThIEREFROMANDTHEBA515FORTHEALLEGEDE%EMP• (ry . . _ V TION.ANYVIOUTIONOFSECTION7037.5BYANYMPUCANTFORAPERMITSU&IECTS7HEAPPLICANTTO Z Re-Roof A CML VENALiY OF NOT MOPE THAtJFIVE HUNORED DOLURS(i50D).): � ❑I,ASOWNEROFTHEPROPERTY,ORMYEMPLOYEESWI7HWAGESASTHEIRSOLECOMPENSATION, � Q Commercial� - � Z WILL DO THE WORK�1D THE STFUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7aa,BUSb �J � NESS ANU PROFESSIONS CODE:THE CON7RACTORS LICENSE UW DOES NOT APPLY TO AN OWNER OF � PpOPEHf1'NTIO BUILDS OR IMPROVES THEREON,AND NMO DOES SUCH WORK NIMSELF OR HERSELF OR � � THROUGH HIS OR HER OWN EMVLOYEES,PHOVIOED 7HA7 SUCH IMPROVEMENTS ARE NOT 1/7rENDED OR m .. w OFFEREDFORSALEISHOWEVERTMEBUILDIN60RIMPROVEMENTISSOLDWfTHINONEYEAROFCAMPLE� Z TION,.7HE OWNER-BVILDER WILL HAVE THE BURDEN OF PROVING iHAT HE OR SHE DID NOT BUIID OR . . . � = IMPROVE FOR THE PURP0.SE OF SALE). � � w ❑1,AS ONMER OF THE PROPERTY,AM EJ(CLUSIVE�Y CONTFiACTINO WITH LICENSED OONTRACTOfiS . � TO CONSTRUCT THE VR0.IECT(SEC.90�/,BUSINESS AND PROFESStONS CODE:7HE CONTMCTORS LI- V81Uflt10f1� ADJ.AREA� W CENSEUWDOESNOTAPPLYTOANOWNEROFAVROPERTYWHOBUILDSORIMPHOVESTHEREON,AND �� WHOCONTMCTSFORSUCHPR0.IECTSWITHACANTRACTOR�S)LICENSEDPURSUANTTOTHECONTRAC pUANTITY � DESCRIPTION FEE � � TORS IICENSE UWJ. . � ❑I AM EXEMGT UNDER SEC. B.8 F.C.FOR THIS REASON Q E C.G�T ICCnI r 5 W'1 ^ Cr � U � OATE OWNER � Z W � UCENSED CONTFIACTORS DECLARATION W � I HEREBYAFFIRAI UNDER PENALTY OF PERJURY THAT I AMlICENSED UNDER 7ROVISIONS OF GIAPTER � - �- � � � Y�COMMENCINO WITH SEC710N 7000)OF DIV1510N 7 OF 7HE BUSINESS AND PROFESStONS CODE,M1D Z - X1 AIY LICENSE IS IN FULL FORCE AND EFFECT. m � UCENSE C SS �� UC.NO.. �7O j � � V DATE CONTRACTOR � �_ � d . . . .. . W � WORKERS'COMPENSATION DECLARATION Q - � C � 1 HEREBV AFFIRAI UNDER PENALTV OF PERIUHV ONE OF THE FOLLOWING OECIARATIONS: Z ' � v � - .� � � � _IHAVEANOWILLMNNTNNACERTIFICATEOFCONSENTTOSELF-INSUREFORWORKERS' _ y Q COMPENSA710N,AS PROVIDED BY SECTION 370o OF iHE LABOR CODE,FOR THE PERFORMANCE U � � C�► Q OF h1E WORK FOR Vh11CH THI3 PERMIT IS ISSUED. � � � � � � �I HAVE AND WILL MAIMAIN WOPo(ERS'�COMPENSA710N INSURANCE,AS REWIRED BY SECTION � � � Q 3700 OF THE LABOR CODE.FOR THE PERFORMANCE'OF THE WORK FOR WHICH THIS VERMI715 ISSUED.MY WORKERS'CAMPENSATION INSURANCE CARRIER AND POLICY NUMBEH ARE: CONSTRUCTION�� ¢ �G,�S�lex�o�r�� CARRIER PLANAEVIEW Z0 POLICVNUMBER Li�C AL I�ZRC�1Z � ELECTRIC � . ,�� ¢ 0 (iH9SECf10NNFIDNDTBECpritETIDOFT£PEfMf5F0fiONEHIR�DFim00LLAR5(t10D)ORl.ES51 PLUMBING - . W Z I CEH7IFY THAT IN THE PERFOf1MANGE OF THE.WORK FOR WMICH TNIS PERMIT IS ISSUED,I , MECHANICAL . .o . � I (} SHALL NOT EMPLOV ANY PERSON W ANV IAANNER SOAS TO BECOME SU&IECT 70 THE � � WORKENS'COMPENSATION UWS OF CAIIFORNIA,AN�AGREE TNAT IF I SNOULD BECAME INSPECTION FEE� � SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE VBOR - --- �•` CA E,I S LL FORfHWITH COMPLY W�ITH }OSE PROVISIONS. ' ' � ISSUANCE � 7��9� �e y ��— SMiP p DATE: �Z APPLICANT: J J W�RNINO:FAILURE TO SECURE WORKERS'COMPENSATION COVEMGE IS UNLAWFUL,AND SHALL BE ENERGY P/C �y SUAIECT AN EMPLOYER TO CqIMINAL PENALTIES AND CNIL FWES UP TO ONE HUNDRED TFbUSANU ENERGY PERMIT DOLURS(S10o.000),�IN ADDITON 70 THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN •� J SEC710N 37oE OF hIE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. � p� RETENTION FEE: OCONSTRUCTION LENDING AGENCY QpE.q�� INEREBYAFFIRMUNDER�PENALTYOFPEFLIUHYTHATTHEREISACONSTRUCTIONLENDINOA6ENCY �j� � � �FOR THE PERFORMANCE OF THE WORK FOR WHrCH THIS PERMIT IS ISSUEO(SEC.30v7,CIV.C.). Z W TS LENDEWSNAME S F- LENDER'SADDRE55 /1 /� W ICERTIFYTHATIHAVEREADTHISMPL�CATIONANDSTATEh1ATTHEABOVEINFORIAATIOHISCORRECT. TOTAL FEES � X /- 7 � 1 AGREE TO COMPLY NATH ALl CITV AND COUNTY ORDINANCES AND STATE UWS RELATING TO BUIIDINO , � U � CANSTFUCTION,AND HEREBV AU7FIORIZE REPRESENTATNES OF 7HI5 CWN7V TO ENfER UPON THE � Z ABOVE-MEMIONEO PROPERTY FOR INSPELTqN GURPQSES. COMMENTS � ' - � �'Q.V'(.Y� �C�Yl1FX�2T m VE EE NAME(PRINn " - � cn ��-u�L � `7/��'1�lZ... � SIGNANRE OF PERMITTEE DAT � RECFT.NO. PAID BY VALIDATION WHITE—Department Copy,YELLOW—Ffnence Copy,PINK—Assessor Copy,GOLDENROD—Fle Copy,GREEI�Applkant's Copy - CITY OF DIAM�ND BAR + , lNSPECT90�1 RECORD — � �� — .. _ a � � . . . — � � � -: � i e ,� m� � �� s � `` �� o � � a � ;. - �. ., � -� . w� �.. � :. i . - - '�" .-� - - � '- .� ..-, .. , . ._ .. _ . . ., :. .... ..K�. . ,. SET B/�Cf< ;FLOOR JOIST __ _ __ __ _.___ - ------ -___ -- --_ —_ - - ----- ------ - ----- ---- — _._ FTGS,FORMS!STEEL �FHA REQMTS -- - --- ---- --- -------- -- ----__._ _._. _..____.-- - - --_.._ ___ ----- ---- ------ ------- -- --- ELECTRIC GROUNQ UNDER FLOOR DUCT GROURQ PLU�161NG i UNDER FLOOR CONDUIT SLAB GRADE i FIREPLACE FOUNDATION TEMP PdUVER �fIREPIACE BOND BEAM WATER SERVICE �MID HT.BOND BEAM ROOF SHEATHING �8 FT.BOND BEAM FRAMING/VENTILATION �FINAL BOND BEAM ---------------_----------------- ------ I----._..__..—...--- ------ --------.._ .__._.._..---------------- ROOF COVER �PRE-GRAQING ----------------------- ----- ----------- !------....._._._...._------...----._...-------......----------..._._._..------------.._......_._...------ ROUGH HEATING ;BENCHING ------ ----- --------- �------------------- ------------------------- ROUGH ELECTRIC ;ROUGH GRADIf�G ROUGH PLUMBING 'FINISH GRADING SHQWER/TUB TEST �POOL ELECTRIC EXT.LATH,SIDING i POOL FENCING WALL INSULATION �POOL FINAL CEILING INSULATION �OFF SITE IMPS. DRYWALL NAILING____ _ �DEDICATIDNS __ _ ___ ____________ -- � SEWER FINAL ENG. SEPTICTANK _ �LANDSCAPE/IRRIG. _ _ SEEP PIT!L.L. ON SITE IMPS. GAS AIRTEST � 'FINAL ZONING FINAL CONST. j FIRE DEPT.FINAL FINAL HEATING � ;HEALTH DEPT.FINAL FINAL ELECTRIC ;DEV.FEES PAID FINAL PLUMBING �ENERGY FINAL PLANING FINAL ENGINEERING � • � o ',a�,;.�"�� • COMMENTS SEPTICTANKSIZE SEEP PIT/U SIZE � �� v � � ; ��,� � �� = - -- --------�—��--- -- -- � � �� a Y, ��3� � ,� . _ a�� .E �� _ - —____----_ __ ' _ —_'— y��i:�;'�"'"{��,�'�_ �• -a+�s-�,'-��. `�, � �.. _ _ _. ____ '----_' —_—._'.—__-- [ • ' CERTIFICATE OF FIELD VERIFICATION &DIAGNOSTIC TESTING CF-4R-MECH-21 I Duct Leakage Test — Existing Duct System (Page 1 of 2) Site Address: 22610 Blue Palm Ln, Diamond Bar CA 91765 (System Enforcement Agency: Permit Number:. 1� City of Diamond Bar 12914 Enter the Duct System Name or ldentification/Tag: System 1 Enter the Duct System Location or Area Served: Whole House Note: Submit one Installation Certificate for each duct sysrem that must demonstrate compliance in the d welling. ' This installation certificate is required for compliance for alterations and additions in existrng dwellings tc space conditioning systems and duct systems. Note: For existing dwellings, a completely new or replacement duct system can also indude existing parts of the original duct system (e.g., register boots, air hand/er, coil, p/enums, etc.) if those parts are accessiblE and they can be sea/ed. For a comp/etely new or rep/acement duct system rnstalled in an existing dwelling, use the Installation Certificate titled "Duct Leakage Test- Completely New or Replacement Duct System." Duct Leakage Diagnostic Test-existing duct system Select one compliance method from the following faur choices. 0 1. Measured leakage less than 15°/a of tan flow ' �Z. Measured leakage to outside less than 10% of Fan Flow �3. Reduce leakage by 60%and conduct smoke and fix all leaks �4. Fix all accessible leaks using smoke and HERS rater verify Note: (One of Options 1, 2, or 3 must be attempted before utilizing Option 4.) Determine nominal Fan Flow using one of the following three calculation methods. ✓�Cooling system method: Size of condenser in Tons 5 x 400 = 2000 CFM ��Heating system method: 21,7 x_Qutpuk Capacity in Thousands of Btu/hr=_CFM ✓�Measured system airflow using RA3.3 airfilow test procedures: CFM Option 1 used the�: 1 Allowed leakage = Fan Flow 2000 x D.15 = 3Qp CFM Actual Leakage = 291 CFM Pass if Leakage Actual is less than Albwed Pass Fail Option 2 used then: 2 Allowed leakage = Fan Flow x 0.10 =_CFM Actual Leakage to outside =_CFM Pass if Leakage Adua1 is less than A1lowed �Pass�Fail Option 3 used then: Initial leakage prior to start of work = CFM Final leakage after sealing all accessible leaks using smoke test =_CFM 3 Initial leakage_- Final leakage_= Leakage reduction CFM ((Leakage redudion_/Initial leakage_)x 100% _ "/o Reduction Pass if"/o Reduction > 60% p Pass p Fail Option 4 used then: 4 All accessible leaks repaired using smoke. HERS rater must verify (No sampling). No smoke allowed to leak from system.Including ducts, plenums, air handler and door panel. Pass if all accessible leaks have been repaired using smoke �Pass�Fail Reg: 212-A0039229A-M2100001A-M21A Registration Date/Time: 2012/OS/13 20:51:19 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 CERTIFICATE OF FIELD VERIFICATION &DIAGNOSTIC TESTING CF-4R-MECH-21 Duct Leakage Test — F�cisting Duct System (Page 2 of 2) Site Address: 22610 Blue Pdfm Ln, DiamOfld Ber CA 91765(SyStem Enforcement Agency: Permit Number: 1� City of Diamond Bar 12914 �Outside air(OA), ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off during duct leakage testing. CFI OA ducts that utilize controlled motorized dampers, that open only when OA ventilation is required to meet ASHRAE Standard 62.2, and close when OA ventilation is not required, may be configured to the ctosed position during duct leakage testing. �All supply and return register boots must be sealed to the drywall if smQke test is utilized for compliance — applies to duct leakage compliance option 3 (leakage reduction by 6D%) and option 4 (fix all accessible leaks) described above. � New duct installations cannot utilize building cavities as plenums or platform returns in lieu of ducts. � Mastic and draw bands must be used in combination with cloth backed rubber adhesive duct tape to seal leaks at_all new duct.cvnnectians. z DECLAiWTIOIV STAYEMENT . I certify under penalty of perjury,under tfie laws of the State of Califvmia, the infvrmation prvvided on this foim is true and correct. . I am the certified HERS rater who pertormed the veritication services identified and reported on this certificate(responsihle rater). . The installed feature,material,component,or manufactured device requiring HERS ver�cation that is identified on this ceitificate(the installation)complies with the applicable requirements in Refereuce Residential Appendices RAZ and RA3 and the requirements specified on the Certificate(s)of Compliance(CF-1R)approved by the bcal enforcement agency. . The information reported on applicable sections of the Installation Certificate(s)(CF-6R),signed and submitted by the person(s) responsible for the installation conforrns to the requlrements specified on the Cer[ificate(s)of Compliance(CF-iR)approved by the enforcement agency. Builder or Installer information as shown on the Installation Cert�cate(CF-6R) Company Name: (Installing Subcontractor or Generaf Contractor or Builder/Owner) SERVICE CHdMPIONS INC Responsible Person's Name: CSLB License: Garrett Stephenson 7991Z0 HERS Provider Data Registry Information Sample Group # (if applicable): N�p Q tested/verified dwelling ❑not-tested/verified dwelling in a HERS sample group HERS Rater Information CaICERTS Certificate#CC1-1798675671 HERS Rater Company Name: The Energuy CA LLC Responsible Rater's Name: Responsible Rater's Signature: William David Painter William David Pnirtter Responsible Rater's Certifiotion Number w/this HERS Provider: Date Signed: 8/13/2012 CC2005784 Reg: 212-A0039229A-M2100001A-M21A Registration Date/Time: 2012/08/13 20:51:19 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Foxms March 2010 , i CERTIFICATE OF FIELD VERIFICATION &DIAGNOSTIC TESTING CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 5) Site Address: Enforcement Agency: Permit Number: � 22610 Blue Palm Ln, Diamond Bar CA 91765 City of Diamond Bar 12914 Note:If installation of a Charge Indicator Disp/ay(CID)is utilized as an alternative to refrigerant cha�ge verification for complianc�, a MECH-24 Certificate(instead of this MECH-25 Certificate)shou/d be used to demonstrate wmpliance with the ref�ige�ant charge verification requirement. TMAH and STMS are not required for mmpliance, when a CID is utilized for complianc�. As many as 4 systems in the dwelling can be documented for compliance using.this form.Attach an additiona/form(s)for any additional systems in the dwelling as applicable_ Temperature Measurement Access Holes (TMAH) and Saturation Temperature Measurement Sensors.(STMS). Procedures for installing TMAH are spec�fied in Reference Residentia!Appendix R,43.2. If refrigerant charge verification is required for compliance, TMAH are also required fnr rnmplianc�. STMS are only required fo�rnmp/ete/y new or rep/acement space-conditioning systems that utilize prescriptive cnmpliance method. I TMAH-Access Holes.in Supply and Retucn Plenums of Air Handler System Name or ldentification/Tag S�rstem 1 System Location or Area Served Who1e House 1 O Yes �No 5/16 inch (8 mm) access hole upstream of evaporative caiS'tn the setum plenum and (abeled according to Figure in 5ection RA3.2.2.2.2. - Z 0 Yes ❑No 5/16 inch (8 mm) access hole downstream of evaporative coil in the supply plenum and labeled according to Figure in Section RA3.2.2.2.2. Yes to 1 and Z is a pass. Enter Pass or Fail ✓ 0 Pass, ✓ ❑ Fail. STMS-Sensor on the Evapvrator CoiB System Name or ldentification/Tag System 1 The sensor is factory installed, or field installed according to manufacturer's 3 ❑Yes ❑No specifications, or is installed by methods/specifications approved by the Executive Director. The sensar wire is terminated with a standard mini plug suitable for connection to a 4 ❑Yes ❑No digital thermometer.The sensor mini plug is accessible to the installing technician and the HERS rater without changing the airflow through the condenser coil 5 ❑Yes ❑No When attached ta a digital thermameter,the sensor provides an indication of the saturation temperature of the coil. Yes to 3,4, and 5 is a pass. Enter N/A if STMS are nat ,/ p N/A ✓ ❑Pass ✓ ❑Fail applicable.Otherwise enter Pass or Fail STMS-Sensor on the Candenser Coil System Name or ldentificatian/Tag S�rstem 1 The sensor is.factory installed, or field installed.according to manufacturer's 6 ❑Yes ❑No specifications, or is installed by methods/specifications approved by the Executive Director. The sensor wire is terminated with a standard mini plug suitable for connection to a 7 ❑Yes ❑No digitaf,thermometer. The sensor mini pfug,is accessibfe to the instaffing technician. and the HERS rater without changing the airflow through the condenser coil 8 ❑Yes ❑No When attached to a digital thermometer, the sensor provides an indication of the saturation temperature of the coil. Yes to 6, 7, and 8 ia a pass. Enter N/A if STMS are not applicable. Otherwise enter Pass or Fail � �N/A ✓ ❑Pass ✓ ❑Fail Reg: 212-A0039229A-M2500001A-M25A Registration Date/Time: 2012/08/13 20:53:14 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 I CERTIFICATE OF FIELD VERIFICATION &DLa►GNOSTIC TESTING CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5) Site Address: Enforcement Agency: Permit Number: 22610 Blue Palm Ln, Diamond Bar CA 91765 City of Diamond Bar 12914 Standard Charge Measurement Procedure(for use if outdoor air dry-bulb is above 55°FJ Pracedures Ior determining Refrigerant Charge using the Standard Charge Measurement Procedure are available in Refefertce Residential Appendix RA3:2.As many as 4 systems in the dwelling can be documented for mmpliance using this form.Attach an additional form(s)for any additional systems in the dwelling as applicable. � •The system should be installed and charged in acaordance with the manufacturers spec�cations before starting this procedure.. •The system must meet minimum airtlow requirements as prerequisite Tar a valid refrigerant charge test. •If outdoor air dry-bulb is 55°F or bebv✓, the instaJler must use the Alternate Charge Measurement Procedure. Space Conditioning Systems System Name or ldentification/Tag S}istem 1 System Location or Area Served Whole House i Outdoor Unit Serial # 5812e09819 I Outdoor Unit Make lennox Outdoor Unit Model xc14O6023a14 Nominal Cooling Capacity Btu/hr 600Q0 Date of Verification 8/13/2012 Catibration of Diagnastic Instruments Date of Refrigerant Gauge Cafibration 8/1/2012 (must be re-calibrated monthly)_ Date of Thermocouple Calitrration 8/1/2Q12 (must 6e re-calibrated monthly) Measured Temperatures ('F). System Name or ldentification/Tag 5yrstem 1 Supply (evaporator leaving) air dry-bulb 52 temperature (Tsupply, db� Return (evaporator entering) air dry-bulb temperature (T 74 return, db� Retum (evaporator entering) air wet-bulb temperature (T ) 6T retum, wb Evaporator saturation temperature 40 �Tevaporator, sat� Condensor saturation temperature 116 �Tcondensor, sat� Suction line temperature(Tsuction� 58 Liquid Line Temperature (T��q��d) 103 Condenser(entering)air dry-bulb 102 temperature (T�ondenser, db� Reg: 212-A0039229A-M2500001A-M25A Registration Date/Time: 2012/08/13 20:53:14 HERS Provider: Ca10ERTS, Inc_ 2008 Residential Compliance Foxms March 2010 � INSTALLATION CERTIFICATE CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5) Site Address: Enforcement Agency: Permit Number: 22610 Blue Palm Ln, Diamond Bar CA 91765 City of Diamond Bar iZ914 Minimum Airflow Requirement Temperature Split Method Calculations for determining Minimum Airflow Requirement for Refrigerant Charge Verification.The temperature split method is specified in Reference Residential Appendix RA3.2. System Name or ldentification/Tag System 1 Calculate: Actual Temperature Split =Treturn, 22.00 db -Tsu I db � Target Temperature Split from Table RA3.2-3 19.3 using Tretum, wb and Tretum,db Calculate difference: Actual Temperature Split- Z � Target Temperature Split = Passes if difference is between -4°F and +4°F or, upon remeasurement, if between -4�F and ppSS -100'F Enter Pass or Fai Noie: Temperature Split Method Calculation is not rtecessary if actual Cooling Coi!Airflow is verified using orte of the airflow measurement proaedures specifled in Reference Residential Appendix RA3.3. If actua!rnoling c�oi!airflow is measured, the value must be equal to or greater than the Calculated Minimum Airflow Requirement in the table below: Cakulated Minimum Airf�ow Requirement(CFM) = Nominal Cooli�g Capacity{ton)X 300 (cfm/ton) System Name or ldentification�T'ag Calculated Minimum Airflow Requirement(CFM} . Measured Airflow using RA3.3 procedures(CFM) Passes if ineasured airFlow is greater than or equal to the calculated minimum airflow requirement. Enter Pass or Fai Superheat Charge IKethod CalcuLations for Refrigerant Charge VeriFcation,This procedure is required to be used for fixed orifice metering device systems System Name or ldentification/Tag Calculate: Adual Superheat = Tsuction -Tevaporator, sat Target Superheat from Table RA3.2-2 using Treturn, wb and T�ondenser, db Calculate difference: Actual Superheat-Target Superheat= System passes if difference is between -6°F and +6°F Enter Pass or Fai Reg: 212-A0039229A-M2500001A-M25A Registration Date/Time: 2012/08/13 20:53:14 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 �I INSTALLATION CERTIFICATE CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5) , Site Address: Enforcement Agency: Permit Number: 22610 Blue Palm Ln, Diamond Bar CA 91765 City of Diamond Bar 12914 Subcooling Charge Method Calculations for Refrigerant Charge Verification.This procedure is required to be used for thermostatic expansion vafve (TXV),and electronic expansion valve (EXV) systems. System Name or ldentification/Tag System 1 Calculate: Actual Subcooling = 13.0 ' Tcondenser, sat-Ttiquid ITarget Subcooling specified by manufacturer 10 Calculate difference: 3 Actual Subcooling -Target Subcooling = System passes if difference is between -4�F and +4�F PASS Enter Pass or Fail Metering Device Calculations for Refrigerant Charge Verification.This procedure is required to be used for thermostatic expansion valve(TXV) and electronic expansion valve{EXV)systems. System Name or ldentification/Tag System 1 Calculate: Actual Superheat = 18.0 Tsuction "Tevaporator, sat Enter allowable superheat range from manufacturer's specifications(or use range 425 between 3'F and Z6�F if manufacturer's specification is not availahlej System passes if actual superheat is within the allowable superheat range PdSS Enter Pass or Fai Reg: 212-A0039229A-M2500001A-M25A Registration Date/Time: 2012/08/13 20:53:15 HERS Provider: Ca10ERTS, Inc_ 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5) Site Address: Enforcement Agency: Permit Number: 22610 Blue Palm Ln, Diamond Bar CA 91765 City of Diamond Bar 12914 Standard Charge Measurement Summary: System shall pass both refrigerant charge criteria,metering device criteria (if appiicable), and minimum cooling coi airFlow criteria based on measurements taken concurrently during system operation. If corrective actions were taken, al applicable verification criteria must be re-measured and/or recalculated. , System Name or ldentification/Tag System 1 System meeks all refrigerant charge and airflow requirements. PASS ' Enter Pass or Fail DECLARATIOM STATEMENT . I certify under penatty of perjury,under tlie taws of the State of California,the information provided on this form is true and correct. . I am the certified HERS raterwho performed the verification services identified and reported on this certificate(responsible rater). . The installed feature,material,component,or manufactured device requiring HERS verification that is identified on this ceitificate(the installation)complies with the applim6le requirements in Reference RPsidential Appendices RA2 and RA3 and the requirements specified on the Certifiqte(s)of Compliance(CF-1R)approved by the Incal enforcement agency. . The information[eported on.appficabfe sections of the Installation.Ceitificate(s) (CF-6R),signed and submittetl Dy the person(sj responsible tor the installation conforms to the requirements specified on the Certiticate(s)ot Compliance(CF-1R)approved by the enforcement agency. Builder or Installer information as shown on the Installation Certificate(CF-6R) Company Name: (Installing,Subcontractor or General Contractor or Builder/Owner) SERVICE CHAMPIONS INC Responsible Person's Name: CSLB License: Garrett Stephenson 799170 HERS Provider Data Registry Information Sam le Grou # if a licable N p ❑not-tested/verified dwelling in P P � PP )� / �tested/verified dwelling a HERS sample group HERS Rater Information CaICERTS Certificate#CC1-1798675671 HERS Rater Company Name: The Energuy CA LLC Responsible Rater's Name: Responsibfe Rater's Signature: William David Painter Willinm David Pairrter Responsible Raters Certifi�tion Number w/this HERS Provider: Date Signed: g�13/2012 CC2005784 Reg: 212-A0039229A-M2500001A-M25A Registration Date/Time: 2012/OS/13 20:53:14 HERS Provider: Ca10ERTS, Inc_ 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-6R-MECH=O Space Conditioning Systems, Ducts and Fans (Page 1 of 2) Site Address: 22610 Blue Palm Ln, Diamond Bar CA 91765 (System Enforeement Agency: Permit Number: 1� City of Diamond Bar 12914 Space Conditioning Systems Heating Equipment Duct E�ciency Location Equip (AFUE, (attic, I Type ARI #of etc.)1, 3 crawl- Heating Heating h(�ac e- CEC Certified Mfr. Name Reference Identical >=CF-1R s ace Duct Load Ca acit t pum p) and Model Number Number2 Systems (value)4 etc.) R-value (kBtu/hr) (kBtu/hr) Split lennox Furnace s1280uh090xv60c03 1 80 AFUE Other 70 88 kBtu Coolieg Equipment Efficiency Dud Equip (SEER Location Type and EER) (attic, (package ARl #ot 1,3 crawM Cooling Cooling heat CEC Gertified Mfr.Name Reference Identical (>=CF-iR space, �uct Load Capacity pump) and Mode1 fVum6er Number2 Systems va{ue)4 etc.� R-value tk8tujt�s) {kBtu/hr) Split lennox A/C xc1406023014 1 14 SEER Qther 60 5 lons 1. If project is new construction, see Footnotes to Standards Table 151-8 and Tab/e I51-C for duct ceiling alternative complianc�e. 2. ARI Reference Number can be found by entering the equipment mode/number at http://www.aridirectory.org/ari/ac.php# 3. Listed efficiency on this page must be greater than or equal( ?)to the value shown on the CF-�R form. 4. When CF-IR is reference it is a/so applicable to the CF-ZR, CF-IR-AA or CF-IR-ALT ALL BOXES MUST BE CHECKED TO BE A VALID FORM 0 §110-§113: HVAC equipment is certiEied by the California Energy Commission. � §150(h): Heating and/or cooling loads calculated in accordance with ASHRAE, SMACNA, or ACCA. 0 §150(i): Setback Thermostat on all applicable heating and/or cooling systems meet the requirements of §112(c). � §150(j)2: Pipe insulation for cooling system refrigerant suction, chilled water and brine lines meets minimum requirements of Table 150-8 and includes a vapor retardant or is enclosed entirely ir conditioned space. Reg: 212-A0039229A-M0400001A-0000 Registration Date/Time: 2012/OB/13 20:46:38 HERS Provider: Ca10ERTS, Inc_ 2008 Residential Compliance Foxms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-0 Space Conditioning Systems, Ducts and Fans (Page 2 of 2) Site Address: 22610 Blue Palm Ln, Diamond Bar CA 91765 (System Enforcement Agency: Permit Number: 1� City of Diamond Bar 12914 Ducts and Fans §150(m): Duct and Fans � 1. All air-distribution system ducts and plenums installed, sealed and insulated to meet the requirements of CMC Sections 601, 602, 603, 604, 605 and Standard 6-5; supply-air and return-air ducts and plenums are insulated to a minimum installed level of R-4.2 or enclosed entirely. ir conditioned space. Openings shall be sealed with mastic, tape or other duct-closure system that meet=_ the applicable requirements of UL 181, UL 181A, or UL 1816 or aerosol sealant that meets the requirements of UL 723. If mastic or tape is used to seal openings greater than �/a inch, the combinatior . of mastic and either mesh or tape shall be used; and � 1. Building cavities, support platforms for air handlers, and plenums defined or constructed with materials other than sealed sheet metal, duct board or flexible duct shall not be used for conveyinc conditioned air. Building cavities and support platforms may contain ducts. Ducts installed in cavities and support platforms shall not be compressed to cause reductions in the cross-sectional area of the ducts. 0 2D. Joints and seams of duct systems and their components shall not be sealed with cloth back rubber adhesive duct tapes uRless such tape is used i� combi�ation with mastic and draw bands. 0 7, Exhaust fan systems have batk draft or automatic dampers. 0 8. Gravity ventilating systems serving conditioned space have either automatic or readily accessible, manually operated dampers. 0 Protection of Insulati4n. Insulation shall be protected from damage, including that due to sunlight, moisture, equipment maintenance, and wind. Cellular foam insulation shall be protected as above or painted with a coating that is water retardant and provides shielding from solar radiation that can cause degradation of the material. � 10. Flexible ducts cannot have porous inner cores. DECLARATION STATEMENT I .I certify under penalty of perJury,under tlre laws of tlfe StaYe of California, tlie iriformaYion provided w�tlris form is true and correct. .I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construttion,or an authorized representative of the person rPsponsible for construction{responsible person). .I certify that the installed featur�,materials,components,or manufactured devi�es identified on this certificate(the instaltation) confortns[o ap applicable codes and regulations,and the instapation is ronsistent with the plans and specifirations approved by the enforcement agency. .I reviewed a copy of the Certifiqte of Compliance(CF-1R)form approved by the enforcement agency that identifies the spe[ific requirelnents for the installation.I oertity that the requireme�ts detailed on the CF-1R that apply to the installation have been met. .I will ensure that a completed,signed copy of this Installation C�tificate shall be posted,or made available with the building permit(s)issued for the building,and made available to the enforcemert agency for all applicable irupections.I understand that a signed c�opy of this Installation CertiFcate is required to be induded with Mre documentaRon the builder provides to the building owner at occupancy. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) SERVICE CHAMPIONS INC Responsible Person's Name: Responsibie Person's Signature: Garrett Stephenson 6arrett Stephenson CSLB License: Date Signed: position With Company (Title): 799170 7/20/2012 Reg: 212-A0039229A-M0400001A-0000 Registration Date/Time: 2012/08/13 20:46:38 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-NIECH-2I-HERS Duct Leakage Test - Existing Duct System (Page 1 of 2) Site Address: Enforcement Agency: Permit Number: 22610 Blue Palm Ln, Diamond Bar CA 91765 (System City of Diamond Bar 12914 1) Enter the Duct System Name or ldentification/Tag: System 1 Enter the Duct System Location or Area Served: Whole House Note: Submit one Instal/ation Certificate for each duct system that must demonstrate compliance in the d welling. This installation certificate is required for compliance for a/terations and additions in existing dwellings tc space conditioning systems and duct systems. Note: For•existing dwellings, a completely new orreplacement duct system can also indude existing parts of the original duct system (e.g., register boots, air handler, coil,plenums, etc.) if those parts are accessiblE and they can be sealed. For a comp/ere/y new or replacement duct system installed in an existing dwellfng, use the Installation Certificate titled "Duct Leakage Test-Completely New or Replacement Duct System." Duct Leakage Diagnostic Test-existing duct system Select one compliance method from the following four choices, 0 1. Measured leakage{ess than 15a/o of fan flow �2. Measured Ieakage to outside less than 10% of Fan Flow �3. Reduce leakage by 60%and conduct smoke and fix all leaks �4, Fix all accessible leaks using smoke and HERS rater verify Note: (One of Options 1, 2 or 3 must be attempted before utilizing Option 4.) Determine nominal Fan Flow using one of the following three calculation methods. ✓�Cooling system method: Size of condenser in Tons 5 x 4D0 = ZO00 CFM ��Heating system method: 21J x_Output Capacity in Thousands of Btu/hr=_CFM � �0 Measured system airflow using RA3.3 airflow test procedures: CFM Option 1 used then: 1 Allowed leakage = Fan Airflow 2000 x D.15 = 300 CFM Actual Leakage = Z91 CFM Pass if Actual Leakage is less than Albwed leakage �Pass 0 Fail Option 2 used then: Z Allowed leakage = Fan Airflow x 0.10 =_CFM Actual.Leakage to.o,utside = CFM. Pass if Actual leakage to outside is less than Allowed leakag Pass Fail Qption 3 used then: Initial leakage prior to start of work = CFM Final leakage after seafing a11 accessibte teaks using smoke test =_CFM 3 Initial leakage_- Final leakage_= Leakage reduction CFM ((Leakage reduction_/Initial leakage�x 100% _ %Reduction Pass if%Reduction> 60�/ p Pass p Fail Option 4 used then: 4 All accessible leaks repaired using smoke test. HERS rater must verify(No Sampling). Pass if all aocessible leaks have been repaired using smoke �Pass�Fail Reg: 212-A0039229A-M2100001A-0000 Registration Date/Time: 2012/08/13 20:47:20 HERS Provider: Ca10ERTS, Inc. 2008 Residential Comp2iance Forms � March 2010 INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS Duct Leakage Test — E�cisting Duct System (Page 2 of 2) Site Address: 22610 Blue Palm Ln, Diamond Bar CA 91765 (System �nforcement Agency: Permit Number: 1� City of Diamond Bar 12914 0 Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off during duct leakage testing. CFI OA ducts that utilize controlled motorized dampers, that open only when OA ventilation is required to meet ASHRAE Standard 6Z.Z, and close when OA ventilation is not required, may be configured to the closed position during duct leakage testing. 0 All supply and return register boots must be sealed to the drywall if smoke test is utilized for tompliance —applies to duct leakage comPliance option 3 (leakage reduction by 60%) and option 4 (fix all accessible leaks) described above. � New duct installations cannot utilize building cavities as plenums �r platform returns in lieu of ducts. 0 Mastic and draw bands must be used in combination with cloth backed rubber adhesive duct tape to seal leaks at all new duct connections DECLARATION STATEMEIVT .I certify under penalty of perjury,under the laws of the State of California, ti�e infnrmation prvvided art this foim is[rue and rnrrect. .I am eligible under Division 3 of tlie BusinPss and ProfPssions Code to accept rrsponsibility for construction,or an authorized repr�sentative of[he person rPsponsible fnr construction{responsible person). .I certify that the installed features,materials,companents,or manufactured devices identified on this certificate(the installation) rnnfonns to all applicable codes and r'egulations,and the instaUation is mnsistent with the plans and specifimtions approved by the enforcement agency. .I understand that a HERS rater will check the installation to verity compliance,and that that ii such checking identifies defects,I arr required to take corrective action at my expense. I understand that Energy Commission and HERS provider representatives will alsc 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 wch qualiry assurance checking,the required corrective action and additional checking/[esting,of other installations in[hat HERS sampfe group wifi be performed at my expense. .I reviewed a copy ot the Certifiqte ot Compliance(CF-1R)torm approved by the entorcement agency that identities the specitic requirements for the installation.I certify that the requirements detailed on the CF-1R that apply to the instaifation have been met. .I will ensure that a completed,signed copy of this Installation Certificate shall be posted,or made available with the building permit(s)issued for the building,and made available to the enforcem�t agency for all applicable inspections.I understand that a signed copy of this Installation CerLiFicate is required to be included with the documentation the builder. provides to the building owner at occupancy. I will ensure that all Installation Certificates will come from a HERS provider data registry for multiple orientation alternatives,and beginning October 1,2010,for all low-rise residential buildings. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner} SERVICE CHAMPIONS INC Responsible Person's Name: Responsible Person's Signature: Garrett Stephenson 6urrett Stephenson CSLB License: Date Signed: position With Company(Title): 799170 7/20/2012 Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? ❑Yes ❑No Reg: 212-A0039229A-M2IOOOOlA-0000 Registration Date/Time: 2012/OS/13 20:47:20 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compli�*ice Forms March 2010 INSTALLATION CERTIFICATE* CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 5) Site Address: Enforcement Agency: Permit Number: 22610 Blue Palm Ln, Diamond Bar CA 91765 City of Diamond Bar 12914 Note: If installation of a Charge Indicator Display(CID)is utilized as an a/ternative to�efrigerant cha�ge ve�ification for I complianae, a MECH-24 Certi�cate(instead of this MECH-25 Certrficate)should be used to demonstrate compliance with the refrigerant charge ve�ification r�quirement. TMAH and STMS a�e not�equired for cnmpliance, when a CID is utilized for complianc�. As many as 4 systems in the dwelling can be documented for compliance using this form.Attach an additional form(s)for any additional systems in the dwelling as applicab/e. Temperature Measurement Access Holes (TMAH) and Saturation Temperature Measurement Sensors (STMS) Procedures for installing TMAH are specified in Reference Residentia/Appendix RA3.2. If r�frigerant charge verification is required for rnmpliance, TMAH are also required for complianc�. STMS are only required for comp/ete/y new or �epfacement space-rnnditioning systems that utilize prescriptive cvmp/iance method. TMAH-Access Holes in Supply.and Return Plenums of Air Handlec System Name or ldentification/Tag System 1 System Location or Area Served Who1e House 1 �Yes ❑No 5/16 inch(8 mm) access hole upstream of evaporative cail'tn tt►e setum plenum and labeled according to Figure in Section RA3.21.2,2. 2 0 Yes ❑No 5/16 inch (8 mm) access hole downstream of evaporative coil in the supply plenum and labeled according to Figure in Section RA3.2.2.2.2. Yes to 1 and 2 is a pass. Enter Pass or Fai( ✓ H Pass ✓ ❑. Fail. STMS-Sensor on the Evaporator Coil System Name-or ldentification/Tag System 1 The sensor is factory installed, or field installed according to manufacturer's 3 ❑Yes ❑No specifications, or is installed by methods/specifications approved by the Executive Director. The sensor wire is terminated with a standard mini plug suitable for connection to a 4 ❑Yes ❑No digital thermometer.The sensor mini plug is accessible to the installing technician and the HERS rater without changing the airflaw through the condenser coil 5 ❑Yes ❑No The sensoc measures the satu�ation temQecatu�e of the cail within 1.3 degrees F Yes to 3,4, and 5 is a pass. Enter N/A if STMS are not applicable.Otherwise enter Pass or Fail ✓ 0 N/A ✓ ❑Pass ✓ ❑Fail STMS-Sensor on the Condenser Coi1 System Name or ldentification/Tag System 1 The sensor is factory installed, or field installed according to manufacturer's 6 ❑Yes p No specifications, or is installed by methods/speciFications approved by.the Executive Director. The sensor wire is terminated with a standard mini plug suitable for connection to a 7 ❑Yes ❑No digital thermometer.The sensor mini plug is accessible to the installing technician and the HERS rater without changing the airflow through the condense[coil 8 ❑Yes p No The sensor measures the saturation temperature of the coil within 1.3 degrees F Yes to 6, 7, and 8 is a pass. Enter N/A if STMS are not applicable.Otherwise enter Pass or Fail `� 0 N/A ✓ �Pass �/ ❑Fail Keg: 212-A0039229A-M2500001A-D000 Regiscration DateJTime: 2012f08/13 20:48:51 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5) Site Address: Enforcement Agency: Permit Number: 22610 Blue Palm Ln, Diamond Bar CA 91765 City of Diamond Bar 12914 Standard Charge Measurement Procedure(for use if outdoor air dry-bulb is above 55°F) Procedures ior determining Re/rigerant Charge using the Standani Charge Measurement Procedure a2 available in Reference Residential Appendix RA3.2.As many as 4 systems in the dwelling can be documented for compliance using this form.Attach an additional form(s)for any additional systems in the dwe/ling as applicable. •The system should be insfa!!ed and charged in accordance with the manufacturer's speciFications before starting this procedure. •The system must meet minimum airflow requirements as prerequisite fo�a valid refrigerant charge test. •If outdoor air dry-bulb is 55°F or below,the instalfer must use the A/temate Charge Measurement Procedure. Space Conditioning Systems System Name or ldentification/Tag S�stem 1 System Location or Area Served Whole House Outdoor Unit Serial # 5812e09819 Outdoor Unit Make lennox Outdoor Unit Model xc1406023014 Nominal Cooling Capacity Btu/hr 600Q0 Date af Verification 7/20/2012 Calibration of Diagnostic Instruments Date of Refrigerant Gauge Gali6�ation 7/1/2012 (must be re-ca4ibtated mohthly) Date of Thermocouple Calibration 7/1/2012 (must be re-calibrated monthly) Measured Temperatures('F) System Name or ldentification/Tag S�stem 1 Supply (evaporator leaving) air dry-bulb 52 temperature (Tsupply, db? Retum (evaporator entering) air dry-bulb 74 temperature (Tretum, db� Retum (evaporator enteringj air ovet-bulb 61 temperature (Treturn, wb� Evaporator saturation temperature 40 �Tevaporator, sat� Cvndensor saturation temperature 116 �Tcondensor, sat� Suction line temperature (Tsuction� 58 Liquid Line Temperature (Tliquid� 303 Condenser(entering) air dry-bulb 102 temperature (Tcondenser, db� Reg: 212-A0039229A-M2500001A-0000 Registration Date/Time: 2012/OB/13 20:48:51 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms August 2009 i INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5) Site Address: Enforcement Agency: Permit Number: 22610 Blue Palm Ln, Diamond Bar CA 91765 City of Diamond Bar 12914 Minimum Airflow Requirement Temperature Split Method Calculations for determining Minimum Airflow Requirement for Refrigerant Charge Verification.The temperature sp�it method is specified in Reference Residential Appendix RA3.2. System Name or ldentification/Tag System 1 Calculate: Actual Temperature Sptit =Treturn, 22,00 db-Tsu I db Target Temperature Split from Table RA3.2-3 19.3 using Tretum, wb and Tretum,db Calculate difference: Actual Temperature Split- 2� Target Temperature Split,_ Passes if difference is between -3°F and +3�F or, upon remeasurement, if between -3�F and pASS -100'F Enter Pass or Fai Note: Temperature Splrt Method Calculation is not necessary if actual Cooling Coi!Airflow is verified using one of the �, airflow measurement procrdures specified irt Referenre Residentia!Appendix RA3.3. If actual rnoling cnil airf/ow is i measured, the value.must be equaL to or.gceater than the Ca/culated Minimum Airflow Requrrement in the table.below.. Caicul�ted Minimum Airtlow Requirement(CFM) = Nominal Cooling Capacity(ton)X 300 (cfin/ton) � System Name or ldentification/Tag System 1 Calculated Minimum Airflow Requirement(CFM) i Measured Airflow using RA3.3 procedures(CFMj I Passes if ineasured airflow is greaterthan or equal to the calculated minimum airflow requirement, Enter Pass or Fai Superheat Charge Method Calcuiations for Refrigerant Cha�ge Verification.This procedure is required to be used for fixed orifice metering device systems System Name or ldentification/Tag System 1 Calculate: Adual Superheat = Tsuction -Tevaporator, sat Target Superheat from Table RA3.2-2 using Treturn, wb and Tcondenser, db Calculate difference: Actual Superheat-Target Superheat= System passes if difference is between -5�F and +5°F � Enter Pass or Fai Reg: 212-A0039229A-M2500001A-0000 Registration Date/Time: 2012/OS/13 20:48:51 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms August 2�09 . INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerent Charge Verification - Standard Measurement Procedure (Page 4 of 5) Site Address: Enforcement Agency: Permit Number: 22610 Blue Palm Ln, Diamond Bar CA 91765 City of Diamond Bar 12914 Sub000ling Charge Method Calculations for Refrigerant Charge Verification.This procedure is required to be used for thermostatic expansion valve(TXV)and electronic expansion valve (EXV)systems. System Name or ldentification/Tag System 1 Calculate: Actual Subcooling = 13.0 Tcondenser, sat-Tliquid Target Subcooling specified by manufacturer 10 Calculate difference: 3 � Actual Subcooling -Target Subcooling = System passes if difference is between -3°F and +3°F PASS Entec Pass or Fai Metering Device Calculations for Refrigerant Charge Verification.This procedure is required to be used for thermostatic expansion valve (TXV)and electronic expansion valve (EXV)systems. I System Name or ldentification/Tag System 1 Calculate: Actual Superheat= 18,0 Tsuction 'Tevaporator, sat � Enter allowable superheat range from manufacturer's specifications(or use range 425 between 4'F and 25'F if manufacturer's specification is not available) System passes if actua�superheat is within the allowable superheat range PASS Enter Pass or Fai Reg: 212-A0039229A-M2500001A-0000 Registration Date/Time: 2012/08/13 20:�8:51 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Fonns August 2009 , INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5) Site Address: Enforcement Agency: Permit Number: 22610 Blue Palm Ln, Diamond Bar CA 91765 City of Diamond Bar 12914 Standard Charge Measurement Summary: System shall pass both refrigerant charge criteria,metering device criteria(if applicable),and minimum cooling coi airflow criteria based on measurements taken concurrently during system operation. If corrective actions were taken, al applicable verification criteria must be re-measured and/or recalculated. System Name or ldentification/Tag System 1 System meets all refrigerant charge and airtlow requirements. PASS Enter Pass or Fai DECLARATION STATEMEPIT .I certify under penalty of peijury,under the taws of the State of California,the information provided on this form is tiue and rnrrect. .I am eligible under Division 3 vf the BusinPss and ProfPssivns Code to accept respo�sibility for construction,or an authorized representative of the person rPsponsible for construction(responsible person). .I certify that the installed featurPs,materiaL�,components,or manufadured devices identified on this certificate(the installation) confortns to all appliqble codes and regulations,and the installation is consistent with the plans and specifiqtions approved by the , enforcement agency. .-I understand that a HERS rater will check the installation to verify compliance,and that that if such checking identifies defects,I arr required to take mrrective adion at my expense. I understand that Energy Commission and HERS provider representatives will alsc 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 wch 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. .I reviewed a copy of the Certificate of Compliance(CF-iR)form approved by the enforcement agency that identifies the specific requirements for the installation. I certity that the requirements detailed on the CF-1R that apply to the installation have been met. .I will ensure that a completed,signed copy of this Installation CertiTicate 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 I understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. I will ensure that all Installation Certiticates will come from a HERS provider data registry for multiple orientation alternatives,and beginning October 1,2010,for all low-rise residential buildings. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) SERVICE CHAMPIONS INC Responsible Person's Name: Responsible Person'sSignature: Garrett Stephenson 6arrett Siephenson CSLB License: Date Signed: position With Company(Title): 799170 7/20/2012 Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? ❑Yes ❑No Reg: 212-A0039229A-M2500001A-0000 Registration Date/Time: 2012/08/13 20:48:51 HERS Provider: Ca10ERTS, Inc_ 2008 Residential Compliance Forms August 2009