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Home My WebLink About12-1338 CI1'Y OF DIAMOND BAR �"' --"��--- DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � -�� .,; . 21810 Copley Drive,Diamond Bar,CA 91765 (909)83�-7020 Fax(909)861-3117 Building Inspection Ilotline(909)839-7027 ,/ RESS �''�', BUII.DING PERMIT APPLICATION FIRIIALY o DDRIESS�7 ��i►' �/cYN �T�/7'/� DATEiCATlO � L� �� NUMBEf�� /C I � ISSUE TYPE p CC APN LOT TRACT DATE 1 CONST.�(i GROUP p OWNER o ADDRESS ZONING SEfBACKS Z CITY ZIP TEL. FRONT RW p � APPLICANT TEL. REAR ❑ � SIDE/SIDE STREET RW ❑ z Q CONTRACTO � � .a/i/D? �i i SIDE p p� ADDRESS Z3Z L !� ,/ ��`r. � C�Ty GY/��.�SS ZIP O6 V TEL _ p/SF PROPOSED USE��/�� _ o ARCH/ENG/ iz DESIGNER NO.DWEL. NO. NO. � ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � cn DESCAIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFR/ADD/fiEM , O p I HEREBY AFFIRM UN�ER PENALTY OF PEfiIURY THAT I M1 E%EAIPT FROM THE CONTRACTORS lP GaragelCarport W CENSEUWFORhIEFOILOWINGREASON(SEC.70.71.SBUSINESSAND7ROFESSIONSCODE:RNYCITYOR (n U COUIfryWHICMRE0U1riESAPERMITTOCONSTRUCT,ALTER.IMGROVE.OEMOLISH,ORREVAIRANYSTRUG ' w TURE.PH10R TO RS ISSUMICE,ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FIIE A SiGNED W Patio/Deck STA7EMEM THAT HE OF SHE IS LICENSED PURSUANT TO hIE PROVISIONS OF THE CONTMC70RS Ll- -- � CENSE UW(CHAPTER 9(COMMF4CING WITH SECTION 7000)OF DIVISION 9 OF THE BUSINE55 AND PRO- � PooUSpa � FESSIONSCOO�ORTHATHEORSHEISE%EMPTTHEREFROMANDTHEBASISFORTHEALLEGEDEXEMP- (� V TION.ANYVIOUTIONOFSEC!ION7o31.5BYMYAPGLICPMFORAPERMIT5U8JECTSTHEA7PLICANTTO Z Re-Roof � A CIVIL�ENALiY OF NOT MORE THAN FIVE HUNORED DOLLARS(5500).): � ❑I,ASJWNEfiOFTHEGP.07ERTY,ORMYEMPLOYEESWITHWAGESASTHEIF50lECOMPENSATH]N, � CORIIfI0fC131 - Z WILI DO TiE WORK�D THE STRUCTURE IS 110T INTENDED OR OFFERED FOR SALE(SEC.7ou,BU51- _1 NESS AND GROFESSIONS CODE:iHE CONTRACTORS LICENSE UW DOES NOT A7PLY 70 AN OWNER OF /f y /� � PROCERTY WHO BUILOS OR IMPFOVES THEREON,AND YMO DOES SUCH WORK HIMSELF OR HERSELF OR � �T�• F CC 7HROUCHHISORHEROWNEMGIOYEES,GROVIDEDTHATSUCHIAIPROVEMENTSARENO7INTENDEDOR m _ �OOV w OFFEREDFCRSALEIF,FiOWEVER7l1EBUILDINGORIMPROVEMENiISSOLOtNiHINONEYEAROFCAMPLE- 0 TION,7HE OWNER�BU^.DER WILL HAVE THE BURDEN OF PROVING hiAT HE OR SHE DID NOT BUIID OR — Z IMPROVE F"OR THE PU9PoSE OF SALE). ' � OI,ASOWNEROFTNEPROPEHTV,AIAEXCLUSIVE�YCAN7MCTINGWITHIICENSEDCONTRACTOPS W Q TO CAHStRUCT THE PfiOJECT�SEC.7oM,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS L�- VBIUBIlOf1 _ADJ.AREA_ W CENSE UW DOES NOi APGLY TO AN ONT7ER OF A PROPER7Y WHO BUILDS OR IMPROVES iHEREON,AND - — � Wl/OCAN(MCTSFORSUCHPR0.IECTSWIhiACONTRACTOR�S)l10EN5EDVURSUANTTOTHECONTMG ouANnTv DESCRIPTION FEE � Y 70R5 UCENSELAW.). � O I AM EXEMPT UNDER SEC. B.6 P.C.FOR THIS REASON Q � U . — — � OATE _ OWNER_ F¢- - Z ..__..._—_.._ — � 0 -- W _ ___ �Q, LICENSED CONTfiACTORS DECLARATION w Cr 1 HEREBV AFFIRM UNDEF!7'cNALTY OF VEFLIVRY THAT I AM LICENSED UNDER VROVISIONS OF CHAPTER �' d Y(COMMENCINO'NITH SEI:TiON 7000)OF OIVISION J OF TF!E BUSINESS AND PROFESSIONS CODE,AND Z � X IAY LICENSE IS M FULL FOflCE AND[FFECT. m �� LLI 9� �Y � LIGENSE ClASS =ZQ LIC.NO._��J C/ .� � '` U OATE d �Z CONTPACTOR G � I� d -� - ---- - --'----- W u� WORKERS'COMPENSATION DECLARATION ' - � S/�� ^!_/��C�2-_� n'lt` � I HEREPY AFFIRM UNDER PENALTY OF VF.RIURV ONE OF THE FOLLOWINu DEClARn7K1N�,: �Z (�TAN�7 r lIh/1 C] I HAYE AND WILL MAIN7AIN A CERTIF;CATE OF CANSENT TO SELF-INSURE FOR WORKERS' _ QCAMPENSATII.Vl,1�5 PROVIDED BY SECTION 37000F THE LABOR CODE,FOR THE PEFfOPMANCE �U __ _ _ Q \ OF 7HE WORK FOR WHICFi 7HI5 PERM�T IS ISSUED. � ' w / ` I HAVE AN�WILL MAINTAIN WORKER'+LOMPENSATION INSURANCE.AS REOUIRED BY SECT:ON Q 770o OF THE l/v50fi CADE,FOR THE PERF'ORM�IICE OF THE WORK FOR WHICH THIS PERMIT IS � ISSUED.MV WOFKERS'COMPENSATION INSURANCE CMRIER AND POLICY NUM6ERME: CONSTRUCTION . ¢ TT�3;`_�/Ao�'FaP� �;.- � - — --- �. CARRIER /� /J�, PLAN REVIEW . _____ � POLICY NUMBERV2 WE'Z�iE(LJ S -- r �. I �__"'_—'__'_.__ , ELE..TRIC � (fYiI55EGf10NNEIDNUTBECOI�.QLEfIDOF7/�PEWyT�ISFORCNEMN�DfimOQl�liS1510010R1.E551 PLUM5ING � - (�'/� � Z i CERTIFY 7HAT IN THE PERFORM/WC'c OF THE VfOfU(FOR WHICM 7HIS 7ERMIT IS I.',SUED,1 MECHANICAL __ �� -]_( )._�_�_ . (3 SHALL NOT EMPLOY ANY PEFi50N IN ANY MaNNER 50 AS 70 BECAME SU&IECT TO THE � ~�T i f� I N NKIRXERS'COMPcN5A710NLAWSOFCALIFOHNIAANOAGNEETHATIFI51i0ULD0ECOME INSPECTIONFEE _ � � = SUBJECT TO hiE WOR)(ERS'COMGENSATION PROYISIONS Of SECTION 770o OF THE U90R � �� CADE.1 SHALL FOHIMMTH COMP�Y Wlhi THOSE PROVISIONS/.f /� �SSUANCE � DATE: // / �T'sS?/1�0��+✓ /7�/�-CrOIt(JJ/�/ON/N �SMIP p �` AFPLICANT: J . --- J WAR7JIN(3:FAIWRE TO SECURE WOR1(ERS'CAMPENSATION CAVEMGE IS UNUV/FUL,AND SHALL BE ENERGY P!C . � SUBJECTAN EMPIOYER TO CFIMINAL PEN,iLTIE5AN0 CIVIL FINES UP TO ONE HUNDRED 7110USAND ENERGY PEFiM1T DOLURS(5100,0001,IN AD71710N TO7HE COST OF CAMPENSATION,DMIAGES AS PHOVIDED FOR IN --�-y}�r J SECTION 370E OF THE tABOR CODE.INTEREST,ANO�T7'ORNEYS FEES � ' `� � RETENTION FEE: _____ _ OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: _ ' ,' � I HEREBY AFFIRM UNDER PENALTY Of PERIURY THAT THERE IS ACANSTRUCT�CN LENDINO AGENCY � � d FOR TNE PERfORMANCE OF THE WOR)(FOR WHICH THIS GERMIT IS ISSUE�(SEG 3097,CIV.C.). — — ' Z W — � LENDER'S NAME_ _ ___ F- LENDER'S AUDRESS .� w I CERTIFV THAT I HAVE READ THIS AVPLICATION AND STA7E T1A7hIE ABOVE INFORMATION IS CORAECT. TOTAL FE ES � I AGREE TO COMPLY N7'(H ALL CI1Y M!D CAUNTY ORDINANCES M1D STATE LAWS REUTING TO BUILDING � CONS7RUCTION,M1D HEREBY AUTHORRE REPRESENTATIVES OF THIS CWNT'!TO EtrtEH UPON iHE � � Z �BOVE�MENTIONED PROPERTY FOP INSPEC710N VUAPOSES. COMMENTS � Ja T � m PERMIRF AA/E(iRINn � � �v � 9� � SIG R F PER ITT � E = RECPT.NO. PAID BY VALIQATION ~ WHITE—Department Capy,YELLOW—Fnance Copy, ,K—Assessor Co ,GOIDENRO�Ie Copy;GREEN—ApplicanYs Capy '�';��a�b� ,•.��= _�'i:'�u'�i`.`'''�i,..: .:"3��`�k"� ��y��i�:„�,��9�g i';: ,? .� .��.,,'��4`'�Q..] • . � -� . ��.., i . .. _ .. �ro � '.r '�-:n ..F- e . r - - � 4 w ._Y y ti. tti� 'I� f�(�''r x"'� ��'t�°�.. .`` y I y♦,:� k .� t � � � n'F^7� ��E3Fflr fi �1�'ff � v'�"•r� 'rf±�„M � �:.( 4 '�,�_'��'y{"�ir`. M ..;� I l l �"1 . ��SI ��r�r.�t�g 1'3S7 �lil r� ��a��i�� .1 sa�'�,�r`�� . �. a�1. � �l�k.��e�4r�� l:�4��11�_';l. a , ��y 4�y _.,t�47��t�-At� �� "A jE', �'t-�-d,i/i?`�4�. i .,_�..... - � �...... �.I�_6_ c_��'..:.. � �`�- � d+::_._7.�a'Y Y1.3....._..a...._ .�_a._ . .1.....�.+s .��.w.:�, at. ......._., .5...t. ...u.� -...�.."""'_L....�=._.�.».a...�� . ....« . , SETBPCK � I � FL�)OR IOIST I I _. FTGS/FQnW15�,TE�L � ' FHSRFQi�AfS - --- ---- - -- -- ----.. .! --- - -- -- -- - _ --.._. __._.... . , .__ . _ _ ..._._ . .------ _ _..__ ------- ELECTPiC�^OUND � � � ,l.!�JDFR i 1.00P,Dl1CT _ _..-- --. ----- - - ---- ------- ----- _ - --- _ -- C;R�.)UI�!D PLIJ��1P>If IG � i �UNfi R FLOOR CO�IDUIT i ------ --- --------- ' - — --- — -- - --— --- -- --' �LAB GRAUc � � � �rl EPLA�E FOUNOATIOM � _ _.—.'._..._.—_.._.._..__..'____'____.'__"'__—_'_.—_.— ' _ '. ; ' "D_"� --_—__'_ — TEfviP POGVER ' �-------------- --_-_I 'FIRE� L�._E BOND BEANI bVATER SERVICE _ _ MID HT.BOND BEAM � I ROOF SHEATHItdG � ;8 FT.BOND BEAM � I ----�- ---- ---- FRAMINGlVENTILATION i FIfdAL BOPJD BEAM ---------__ --------------------------- ---------------------- :-......------------------- ------- -- ROOF COVER I ;PRE-GRADING -----._..___-----._...___._..- ------------------ -------.._-------- �— _.____...--- -___------.. _ ROUGH HEATIhJG I _ ;Ecf�.ICHING ------------------------------- ----.._...____ __.--------------------- ._....----�------------------_._...- ------__._._.._. ROUGH ELEC�iftlC � �ROUGH GRADING ROUGH PLUMBING I i FINISH GRADING SHOWEP,/TUBTEST � IPOOLELECTRIC EXf.LATH;SIOING I POOL FENCING 4VALL INSUI_ATION � i POOL FINAL _ CEILING R�!SULATION �OFF SITE IMPS. DRY�AIALL h•IAILING i DEDICF�TIONS _._---------------------------------------- -------------_-------.... --- -------___.. SEN/ER rFIP�AL ENG. ---�----------------------------.__------------------ --------�- ------------------------�--- ------------- SEPTICTAtJK �LANDSCAPE/IRRIG. __.__.._._..._-- �--- ----------- --------------- -- G--------------.....____...._._..--------.._.._._._..-- -- SEEP PIT;L.L. �Ofd SITE INiPS. GAS AIRTEST 'FINAL ZO�JING FINAL CONST. � j FIRE DEPT,FINAL FINAL t-IEATING j HEALTH DEPT.FINAL - FINAL ELECTRIC j DEV.FEES PAID FINAL PLUMBING I EMERGY FINAL PLANING j .__--- _ ---- ----------- ------------- ---- --- --------- - -- FINAL ENGII�ItERING _------ ------ --- �� r:� ��-y,"_� .u��.F•. ---- ------- COMMENTS ` ` ' � � � � SEPTIC TANIC 51ZE SEEP PIT/U SIZE �,�;. � �; _ � �� _z�_ i� t ��' — .� ' 4 �i •,��:'�� s ' ��- i . INSTALLATION CERTIFICATE* CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 5) Site Address: Enforcement Agency: Permit Number: 24214 Bryn Athyn Way , Diamond Bar CA 91765 City of Diamond Bar 12-1338 Note: If installation of a Charge Indicator Display(CID) is utilized as an alternative to refrigerant charge verification for compliance, a MECH-24 Certificate(instead of this MECH-25 Certi�cate)should be used to demonst�ate compliance with the refrigerant charge verification requirement. TMAH and STMS are not required for compliance, when a CID is utilized for compliance. 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 Residential Appendix R,43.2. If refrigerant charge verification is required for compliance, TMAH are also requi�ed for compliance. STMS are only required for completely new or replacement space-conditioning systems that utilize prescriptive compliance method. . TMAH-Access Holes in Supply and Return Plenums of Air Handler System Name or ldentification/Tag Systemi System Location or Area Served Whole House 1 �Yes ❑No 5/16 inch (8 mm) access hole upstream of evaporative coil in the return plenum and labeled according to Figure in Section RA3.2.2.2.2. 2 �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 Fail ✓ � Pass � ❑ Fail STMS-Sensor on the Evaporator Coil • . . _ .. System Name or ldentification/Tag";; . Systemi _ ,' The sensor is factory installed, or field installed aceording to manufacturer's 3 ❑Yes ,pNo' ,: specifications, or is�installed by rriethods/specifications approved by the Executive Director, i . The sensor wire is terminated with a standard mini plug suitable for connection to a 4 `p Yes �"l ❑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 The sensor measures the saturation temperature of the coil within 1.3 degrees F Yes to 3,4, and 5 is a pass. Enter N/A if STMS are not ,/ �N/A �/ ❑Pass ✓ ❑Fail applicable, Otherwise enter Pass or Fail STMS-Sensor on the Condenser Coil System Name or ldentification/Tag Systemi The sensor is factory installed, or field installed according to manufacturer's 6 p Yes p No specifications, or is installed by methods/specifications approved by the Executive D i rector. 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 condenser coil 8 ❑Yes ❑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 � �N/A � ❑Pass � ❑Fail � applicable. Otherwise enter Pass or Fail Reg: 212-A0058724A-M2500001A-0000 Registration Date/Time: 2012/10/20 12:58:49 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: 24214 Bryn Athyn Way , Diamond Bar CA 91765 City of Diamond Bar 12-1338 Standard Charge Measurement Procedure (for use if outdoor air dry-bulb is above 55°F) Procedures for determining Refrige�ant Charge using the Standard Charge Measurement Procedu�e are 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 dwelling as applicable. •The system should be installed and charged in accordance with the manufacturer's specifications befo�e sta�ting this p�ocedure. • The system must meet minimum air-flow requirements as prerequisite for a valid refrigerant charge test. •If outdoor air dry-bulb is 55°F or below, the installer must use the Alternate Charge Measurement Procedure. Space Conditioning Systems System Name or ldentification/Tag Systemi System Location or Area Served Whole House Outdoor Unit Serial # 1209581510 Outdoor Unit Make AMANA Outdoor Unit Model Gsx130601ba Nominal Cooling Capacity Btu/hr 60000 Date of Verification 10/16/2012 Calibration of Diagnostic Instruments Date of Refrigerant Gauge Calibration 10/01/2012 (must be re-calibreted monthly) Date ofThermocouple,Calibration ' , i 10/01/2012 (must be re-calibrated monthly) , Measured Temperatures'(°F) ; � , ,� System Name or ldentification/Tag „Systemi . Supply (evaporator leaving) air dry-bulb temperature (Tsupply, db� Return (evaporator entering) air dry-bulb temperature (Treturn, db� Return (evaporator entering) air wet-bulb temperature (Treturn, wb� Evaporator saturation temperature 34.7 �Tevaporator, sat� Condensor saturation temperature g1.5 �Tcondensor, sat� Suction line temperature (Tsuction� ' S1.3 Liquid Line Temperature (Tliquid� ��•9 Condenser(entering) air dry-bulb temperature (T 60 condenser db� Reg: 212-A0058724A-M2500001A-0000 Registration Date/Time: 2012/10/20 12:58:49 HERS Provider: Ca10ERTS, Inc. � 2008 Residential Compliance Forms . August 2009 � INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5) Site Address: Enforcement Agency: Permit Number: 24214 Bryn Athyn Way , Diamond Bar CA 91765 City of Diamond Bar 12-1338 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 Systeml Calculate: Actual Temperature Split = Treturn, db -Tsu I db Target Temperature Split from Table RA3.2-3 using Treturn, wb and Treturn, db Calculate difference: Actual Temperature Split- Target Temperature Split = Passes if difference is between -3°F and +3°F or, upon remeasurement, if between -3°F and -100°F Enter Pass or Fail Note: Temperature Split Method Calculation is not necessary if actual Cooling Coil Airflow is verified using one of the airflow measurement procedures specified in Reference Residential Appendix RA3.3. If actual cooling coil airflow is measured, the value must be equal to or greater than the Calculated Minimum Airflow Requirement in the table below. Calculated Minimum Airflow Requirement (CFM) = Nominal Cooling Capacity(ton) X 300 (cfm/ton) System Name or ldentification/Tag�- ' Systemi Calculated Minimum Airflow Requirement (CFM) 1500 �� ' .': i� MeasuredAirflow.u'sing RA3.3 procedures (CFM.)'' � -� 1568' - Passes if ineasured airflow is greater than or equal to the calculated minimum airflow PASS requirement. Enter Pass or Fail Superheat Charge Method Calculations for Refrigerant Charge Verification.This procedure is required to be used for fixed orifice metering device systems System Name or ldentification/Tag Systemi Calculate: Actual 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 Fail Reg: 212-A0058724A-M2500001A-0000 Registration Date/Time: 2012/10/20 12:58:49 HERS Provider: Ca10ERTS, Inc. I 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5) Site Address: Enforcement Agency: Permit Number: 24214 Bryn Athyn Way , Diamond Bar CA 91765 City of Diamond Bar 12-1338 Subcooling Charge Method Calculations for Refrigerant Charge Verification.This procedure is required to be used i for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or ldentification/Tag Systemi Calculate: Actual Subcooling = 8.6 Tcondenser, sat-Tliquid Target Subcooling specified by manufacturer 7 Calculate difference: Actual Subcooling -Target Subcooling = 1.6 System passes if difference is between -3°F and +3°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 Systemi Calculate: Actual Superheat = 16.6 Tsuction -Tevaporator, sat Enter allowable superheat range from manufacturer's specifications (or use range 4-25 between 4°F and 25°F if manufacturer's specification is not available) System passes if actual superheat is within:the allowable superheat range i I; PASS ' ,-Enter Pass or Fail � . ;�' - r� ;� � i � , �' ' � , Reg: 212-A0058724A-M2500001A-0000 'Registration Date/Time: 2012/10/20 12:58:49 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms 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: 24214 Bryn Athyn Way , Diamond Bar CA 91765 City of Diamond Bar 12-1338 Standard Charge Measurement Summary: System shall pass both refrigerant charge criteria, metering device criteria (if applicable), and minimum cooling coil airflow criteria based on measurements taken concurrently during system operation. If corrective actions were taken, all applicable verification criteria must be re-measured and/or recalculated. System Name or ldentification/Tag Systemi System meets all refrigerant charge and airflow requirements. PASS Enter Pass or Fail � - � , . �� , J 'i � (' ' ' . . _ � � .' __. ' � , 'I �' . , . , ' i�� r'. � . � , DECLARATION STATEMENT .I certify under penalty of perjury,under the laws of the State of California,the information provided on this form is true and correct. .I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction,or an authorized representative of the person responsible for construction (responsible person). .I certify that the installed features,materials,components,or manufactured devices identified on this certificate(the installation) conforms to all applicable codes and regulations,and the installation is consistent with the plans and specifications 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 am required to take corrective action at my expense. I understand that Energy Commission and HERS provider representatives will also perform quality assurence 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. .I reviewed a copy of the Certificate of Compliance(CF-1R)form approved by the enforcement agency that identifies the specific requirements for the installation. I certify 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 Certificate 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 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 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) THOMSON AIR CONDITIONING , Responsible Person's Name: Responsible Person's Signature: Josh Thomson Josh Thomson CSLB License: Date Signed: Position With Company (Title): 959811 10/16/2012 Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? 0 Yes ❑No Reg: 212-A0058724A-M2500001A-0000 Registration Date/Time: 2012/10/20 12:58:49 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms August 2009 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: 24214 Bryn Athyn Way , Diamond Bar CA 91765 City of Diamond Bar 12-1338 � Note:If installation of a Charge Indicator Display(CID)is u[ilized as an alternative to ref�igerant charge verification for compliance, a MECH-24 Certificate(instead of this MECH-25 Certificate)should be used to demonst�ate compliance with the refrigerant charge verification requirement. TMAH and STMS are no[required for compliance, when a CID is utilized for compliance. 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 applicable. Temperature Measurement Access Holes (TMAH) and Saturation Temperature Measurement Sensors (STMS) Procedures fo�installing TMAH are specified in Reference Residential Appendix RA3.2. If refrigerant charge verification is required for compliance, TMAH are also required for compliance. STMS are only required for completely new or � replacement space-conditioning systems that utili2e presc�iptive compliance method. TMAH -Access Holes in Supply and Return Plenums of Air Handler System Name or ldentification/Tag System 1 System Location or Area Served Whole House 1 �Yes p No S/16 inch (8 mm) access hole upstream of evaporative coil in the return plenum and labeled according to Figure in Section RA3.2.2.2.2. 2 �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 Fail ✓ � Pass ✓ ❑ Fail STMS-Sensor on the Evaporator Coil - �._ ... _ .._ .... ... System Name or ldentification/Tag; System 1 _,,--. The sensor is factory installed, or field installed aceording to manufacturer's 3 ❑Yes �p No ; specifications, or is installed by methods/specifications approved by the Executive Director, i The sensor wi�e is terminated with a standard mini plug suitable for connection;to a 4 ❑Yes'`�' p 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 p No When attached to a digital thermometer, 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 not ,i �N/A ✓ ❑Pass � ❑Fail applicable. Otherwise enter Pass or Fail STMS-Sensor on the Condenser Coil System Name or ldentification/Tag System 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 p 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 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 is a pass. Enter N/A if STMS are not � �N/A � ❑Pass �/ ❑Fail applicable. Otherwise enter Pass or Fail Reg: 212-A0058724A-M2500001A-M25A Registration Date/Time: 2012/10/20 13:05:31 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 � CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC '�ESTING CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5) Site Address: Enforcement Agency: Permit Number: 24214 Bryn Athyn Way , Diamond Bar CA 91765 City of Diamond Bar 12-1338 Standard Charge Measurement Procedure (for use if outdoor air dry-bulb is above 55°F) _ P�ocedures for dete�mining Refrigerant Charge using the Standa�d Cha�ge Measurement Procedure are available in Refe�ence 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 dwelling as applicable. •The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedu�e. •The system must meet minimum airflow requi�ements as prerequisite for a valid�ef�igerant charge test. •If outdoor air dry-bulb is 55°F or below, the installer must use the Alte�nate Charge Measurement Procedure. Space Conditioning Systems System Name or ldentification/Tag System 1 System Location or Area Served Whole House Outdoor Unit Serial # 1209581510 Outdoor Unit Make AMANA Outdoor Unit Model Gsx130603ba Nominal Cooling Capacity Btu/hr 60000 Date of Verification 10/20/2012 Calibration of Diagnostic Instruments Date of Refrigerant Gauge Calibration 10/01/2012 (must be re-calibrated monthly) Date ofThermocouple,Calibration . ; , 10/O1/2012 (must be re-calibrated monthly) � Measured Temperatures (°F) ; i' System Name or ldentification/Tag �System i � Supply (evaporator leaving) air dry-bulb _ temperature (Tsupply, db� Return (evaporator entering) air dry-bulb temperature (Treturn, db� Return (evaporator entering) air wet-bulb temperature (Treturn, wb� Evaporator saturation temperature 34.7 �Tevaporator, sat� Condensor saturation temperature g1.5 �Tcondensor, sat� Suction line temperature (Tsuction� 51.3 Liquid Line Temperature (Tliquid� 72•9 Condenser (entering) air dry-bulb temperature (T 60 condenser, db� Reg: 212-A0058724A-M2500001A-M25A Registration Date/Time: 2012/10/20 13:05:31 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5) Site Address: Enforcement Agency: Permit Number: 24214 Bryn Athyn Way , Diamond Bar CA.91765 City of Diamond Bar 12-1338 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 Calculate: Actual Temperature Split = Treturn, db -Tsu I db Target Temperature Split from Table RA3.2-3 using Treturn, wb and Treturn, db Calculate difference: Actual Temperature Split- Target Temperature Split = Passes if difference is between -4°F and +4°F or, upon remeasurement, if between -4°F and -100°F Enter Pass or Fail Note: Temperature Split Method Calculation is not necessary if actual Cooling Coil Airflow is verified using one of the airflow measurement procedures specified in Reference Residential Appendix RA3.3. If actual cooling coil airflow is measured, the value must be equal to or greater than the Calculated Minimum Airflow Requirement in the table below. Calculated Minimum Airflow Requirement(CFM) = Nominal Cooling Capacity (ton) X 300 (cfm/ton) System Name or ldentification/Tag�; j System 1 ' I � i Calculated Minimum Airflow Requirement (CFM) 1500 � // I :I i Measured Airflow-using RA3.3 procedures (CFM)' ' 1568 � Passes if ineasured airflow is greater than or equal to the calculated minimum airflow pASS requirement. Enter Pass or Fail Superheat Charge Method Calculations for Refrigerant Charge Verification.This procedure is required to be used for fixed orifice metering device systems System Name or ldentification/Tag Calculate: Actual 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 Fail Reg: 212-A0058724A-M2500001A-M25A Registration Date/Time: 2012/10/20 13:05:31 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5) ' Site Address: Enforcement Agency: Permit Number: I 24214 Bryn Athyn Way , Diamond Bar CA 91765 City of Diamond Bar 12-1338 Subcooling 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 = 8,6 Tcondenser, sat-Tliquid Target Subcooling specified by manufacturer 7 Calculate difference: 1.6 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 = 16.6 Tsuction "Tevaporator, sat Enter allowable superheat range from manufacturer's specifications (or use range 3-26 between 3°F and 26°F if manufacturer's specification is not available) System passes if actual superheat is"withirrthe ' ' -' ' ' allowable superheat range � PA55 � Enter Pass or Fail ,I,I, ' , . �' . Reg: 212-A0058724A-M2500001A-M25A Registration Date/Time: 2012/10/20 13:05:31 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: 24214 Bryn Athyn Way , Diamond Bar CA 91765 City of Diamond Bar 12-1338 Standard Charge Measurement Summary: � System shall pass both refrigerant charge criteria, metering device criteria (if applicable), and minimum cooling coil I airflow criteria based on measurements taken concurrently during system operation. If corrective actions were taken, all applicable verification criteria must be re-measured and/or recalculated. System Name or ldentification/Tag System 1 . System meets all ref�igerant charge and airflow requirements. PASS Enter Pass or Fail ' ' � ' , � ,, , ,.��` , �, l;, � � � � , , - , , ,. DECLARATION STATEMENT . I certify under penalty of perjury,under the laws of the State of California,the information provided on this form is true and correct. . I am the certified HERS rater who performed the verification services identified and reported on this certificate(responsible reter). . The installed feature,material,component,or manufactured device requiring HERS verification that is identified on this certificate(the installation)complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified on the Certificate(s)of Compliance(CF-1R)approved by the local 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 conforms to the requirements specified on the Certificate(s)of 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) THOMSON AIR CONDITIONING Responsible Person's Name: CSLB License: ]osh Thomson 959811 HERS Provider Data Registry Information Sample Group # (if applicable): N/A �tested/verified dwelling ❑not-tested/verified dwelling in a HERS sample group HERS Rater Information CaICERTS Certificate# CC1-1798701111 I HERS Rater Company Name: MLC Building Performance Responsible Rater's Name: Responsible Rater's Signature: Robert Bachus Rob¢rt Bcchus Responsible Rater's Certification Number w/this HERS Provider: Date Signed: 10/20/2012 CC2005695 Reg: 212-A0058724A-M2500001A-M25A Registration Date/Time: 2012/10/20 13:05:31 HERS Provider: Ca10ERTS, Inc. I2008 Residential Compliance Forms March 2010 �