HomeMy WebLinkAbout14-3669 ,��_�:_-'�_����_. CITY OF DIAMOND BAR i(�. �\I(}�I�l�`
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I ( I _ �i DEYARTMENT OF COMMUI�ITY&DEVELOPM�NT SERVICES
`����n,y � ' 21810 Coplcy Drivc,Di��mond 13ar,CA 91765 � PRESS
. �'�>� (909)839-7020 rax:(909)861-3117 Building Inspection Hotline(909)839-7027
� '�"°�' I3UILDING PER�11T APPLICATION FIRMLY
¢ JOB SITE ADDRESS� �� �• // (/�� J� APPLICATION DATE: P/C#
z APN��, �LOT CT ISSUE DATE: I T PERMIT#_��' � � (�� I
o OWNER �J �/ /� TYPE CONST. OCC GROUP:
N ADDRESS v
ZONING SETBACKS
QCITY� ZIP L. FRONT RW ❑
� APPLICANT TEL. REAR ❑
0
v� /r7 �J2�� �i� �B�J /l SIDE/SIDE STREEf RW ❑
Q CONTRACTOR S� P �` SIDE ❑
o� ADDRESS 7/S' �d� /C� p PROPOSED USE
o� CI��we1Dll/Y—ZIP���� EL. U �
0
o ARCH/ENG/DESIGNER
w
o ADDRESS
�t DWEL.UNITS #STORIES #BEDROOMS
z CIN ZIP TEL.
� DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION.
OWNEfl-BUILDER DECLAflATION
� I hereby aflirm under penatty of Deryury that I am exempt from the Contractnr's State License Law for ihe reason(s) SFR/ADD/REM
p indicated below by the checkmark�s�,I have placed next to the aDD�icable item(s)[Section 703t.5,Business and Garage/Carport
o Professions Code:Any city or county that requires a permit to consUuct,alter,improve,demolisb,or repair,any
z shucture,prio�to i[s issuance,also requires the applicaM for the permit ta file a signed statement that he or she tA patio/Deck
N is licensed pursuant to the provisions of the Contractor's State License Law(Chapter9)Commencing with Section W
N 7000 of Division 3 of the Business and ProfesSions Code]or that he or she is exempl from licensure and the basis for u. Pool/Spa '� � `�
the alleged ezemption.Any violation of Section 7031.5 by any applicant tor a Oertnit subjects ihe applicant to a civil penalry (7
N Z Re-Roof � �
� 01 not more than live huntlred dollars�$500). �
o U I,as owner of lhe properry,or my employees with wages as their sole compensation,will do(�all of or(�portions � Commercial p �� f � �
� of the work,and the sWcture is not intended or offered for sale(Section 7044,Business and Professions Code:The m -
� Contractors'State License Law does not apply to an owner of property who,through employees'or personal ettort,builds
� or improves the properry,provided that ihe improvemenfs are not intended or offered tor sale.If however,the building or .
� improvement is sold within one year ot completlon,the Owner-Builder will have the burden of proving that it was not built
p or improved for the purpose of sale.).
U
u I,as owner oi the property,am exclusively conVacting wiN licensed Cantracrors to construct the project(Section
z 7044,Business and Professions Code:The CoMractors'State License Law does not apply to an owner o1 properry who Vafuation: Adj.Area:
� builds or improves t�ereon,and who conUacis for the projecis witn a licensed Contractor pursuant to the Contracmrs'State QUANTIIY DESCRIPTION FEE
Y license Law.). /
O U I am exempt from licensure under the ConUactor's State License law tor ihe lollowin9 reason(s): �
� �
"—' By my signature below I acknowledge that,except for my personal residence in which I must have resided for at least one c~.� .
� year prior to compledon of Ne improvements covered by this permit,l cannot legally sel�a structure that 1 have built as an W
Q owner-builder if it has not been consiructed in its entireTy by licensed contrac .I understand ihat a copy ot the appliq��e _ �i
� law,Section 7 44 of the' usiness and Professions Code is ava le u quest when this application is submitted or '
X [he fo b site� eginto.ca. �aw.ht Z
o DA P SIGN: �
� LICENSED C TRA T 'S DECLARATION �
a
w I hereby affirm untler penalty of perjury that I am licensed untler provisians of Chapter 9(commencing with Section 7000) '
m ot Division 3 ot ihe Business and Protessions Code,and my license is in full force and ettect. J
/ �J /� /� 3• D � ON
� UCENSE CLASS: l `!/ LIC.NO.:��Z V z �d Q C�O �"�
o DATE CONTRACTOR: ��•-/ � � _
a � WONNEH'S COMP6TJSATION DECLARATION �
� I NEREBY A UNDER PENALTY OF PERJURY ONE Of THE FOLLOWING DECLARATIONS: �
oI have and will maintain a Certifiqte of Consent to Self-Insure for Worker's Compensation,as pmvided by CONSTRUCTION:
� Section 3700 0l the Labor Cade,for the performance of ihe work for which lliis permit is issued. p�qN REVIEW:
> I have and will mainiain Worker's Compensation Insurance,as revuired by Section 3700 of the Labor Code,for
� the pedortnance of the work tor which this permit is issued.My Worker's Compensation Insurance Carrier and ELECTRIC:
Z
a Poli�yNumber� /� PLUMBING:
� CARRIER {L��J�� MECHANICAL:
Z POLICY NUMBER_rI �r_�;C�7
`� -�..— �——: INSPECTION FEE:
� (T}iIS SEC�ION NEED N0T BE COMPLEfED IFiHE PERMR IS FOR ONE HUNDRED DOLLARS($tIX7)OR LESS�.
�= ISSUANCE: ���
o I certify ihat in the pertormance at the work lor which this permit is issued,I shall not empby any person in any manner so as to
0
become subjecl to Ihe Worker's Compensation Laws of California.Md agree ihat if I shwld become subject to the Worker's SMIP:
J Campe isi 1 tion 3700 of e,l sh 1�`vilh pty wf'� se provisions. ENERGY P/C:
LL DATE: �LICAN7:�, _�\� �G � ENERGY PERMIT:
� WAANING FaiNre b sec��re Worker's Compe�lsation coverage is unlawful,and shall subject an employer to cnminal i,7
w penalties and civil fines up to one hundred thousand dollars($100,000),in addi6on to the cost ot the compensation, RETENTION FEE: 4-�
a damages as prwided tor in section 3708 of the labor code,interest,and attomeys tees. PRE-ALT FEE:
0
a CONSTRUCTION LENDING AGENCY BSAF:
,z I hereDy affirm under penalry oi perjury ihat ihere is a ConsVuction Lending Agen�y tor the pedormance of ihe work for �
= which this permit is issued�Sec.3097,Civ.C.).
�
� LENDER'S NAME:
� LENDER'SADORESS:
a I certify that I have read this application and state that ihe above information is correct.I agree to compty with ail ciry and TOTAL FEES�
Z counry ortlinances and state laws relating N building construcfion,and hereby authorize representatives of this counry to COMMENTS:
o ent n the above-m ntioned properry tor inspectio�urposes�
J _/�
_ �T
m
¢ MITTEE ME RI
�
N l
= S NATUR OF PE I EE DATE RECEIPT q PAID BY: C� L VALIDATION:
�--
WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanYs Copy
CITY Of DIAMOND BAR
INSPECTION RECORD
J
� � � s � � � e � � e �
SETBACK/'I:ETfER . ''�: TRACTAND LEDGER
FOOTINGS FO.RMS . � � c'-�. ��'�s . .. -�-� _ ':� SWITCH GEAR
SLAB::'', ,, ,� ,, �,,,`; ��� COMMERCIAL HOOD
UG.PLUMBING��;> = - T-BAR
UG.ELECTRICAL�: . �� _; INTERCEPTER
UFER GROUND�.'� HOT MOP/SHOWERPAN
_ _ .. ,
SEWER LATERAL SEPTIC/CESSPOOL
MAIN WATER LINE HERS REPORT RECEIVED
SEWER CLEANOUT DEMOLITION
ROOF SHEATHING ROOF DRAINS
FLOOR SHEATHING ROUGH CONDUIT
SHEARWALLS EXTERIOR` : �'' r ';' .. . :' _ ` _`.' ;; PUOL/SPA�'` . ' :c. ` �
,
SHEAR WALLS INTERIOR; : .� '` ' � >:' � . ROUGH PLUMBING'�.; �. � - _
, , _
FRAMINGNENTING - :4, �, ;� , ,;�. . ':= , ;' , � `. : ROUGH ELE.CTRICA�_s , -
, , , ; .:
ROUGH,MECHANICAL -: '.<.; .ROUGH MECHANICAL,`� ,� i ; - i,; ^� . .
ROUGH ELECTRICAL W'�)C( ) ;;� ' r ` '+ ` � .GAS TEST .-:,..
'ROUGH•PIUM[iING � '� '' � ' '=` y ="a 3 ' '' PRE"GUNITE, _ -
. _ , , _ ,
INSULATION WALL � RQOLPRE;DECK BONDING = '' $ ' : ' �` _
INSULATION CEILING ` `�t` ""' ` � ' '� " P,=TRAP, ': '
DRYWALL •FENCE./GRTElALARM , �, t ,
LATH(PRE) FINAL POOL - _
LATH EXTERIOR WA��S�
LATN INTERIOR WALL FOOTING/STEEL
GAS TEST WALL STEEL 1sT� �2wo� ����
SCRATCH COAT WALL BOND BEAM
ELECTRIC METER RELEASE WALL DRAIN!SEAL
GAS METER RELEASE WALL FINAL
SPECIAL INSPECTION R0.FRAMIN�PtANNiNGAPPROVAL - •"� - -
, ..._,: . _ - _
,, . ...: „_ , _ . . -
, . ,;
FINAL��BUILDING...� ;�. . ,� �:; . . ` :, ,�� �-.: ._ .. ;".> �ROUGHF,IREAPPROVAL' :. _ �, - � , ,, N s.,
_ . . .•.
FINALMECHANICAL - -.. -�;.. � ���� ` �. � . `.` r�,��;�. -`_� • FINALFIREDEPAF�TME�JT v�: ,.��., ".:. . �:<� -� - -
FINAL;ELECTRICAL. `. FINAL.PLANNING �';;, . � � �' : ,;':
FINAL':PLUMBING FINAL ENGINEERING/PW -
T.C.of OCCUPANCX ` ` - ' FI�NAL COMMUNITY`SERVICES � r
CERL:of OCCUPANCY r- :;: h. ,�',, . . ..:>, . -;' � `- ; :: " �FINAL HEALTH DEPT ,,. -
.: ,:. ., . -
FINAI INDUSTRIAL�WASTE ::_ . ; '::; � F. .. . . _:.'. '
COMMENTS: �/�+ to�q I�
ti �
Prescri`tive Certificate of Com liance: Residential CF-IR-ALT
Residential Alterations Pa e 1 of 5
Project Name: Climate Zone# #of Stories
Paul Burmeister 9 1
General Information
Site Address:2�226 E.Davan St Diamond Bar CA 91765 Enforcement Agency:Diamond Bar,City of Date: 5/28/2014
Building Type�Single Family ❑Multi Family Circle the Front Orientation:�,E,S,W,or degrees
Conditioned Floor Area(CFA): 10154 Project Type: QAlterations ❑Envelope❑Fenestration ❑Roof❑HVAC
Re lacement or Change Out ❑Duct Re lacement ❑Water Heater
NOTE: This forni is not to be used for Newly Constructed Bui[dings or Additions
Insulation Values For Opaque Surfaces(for Furring use the Mass and Furriitg Sh•ips Construction table below)
Assembly Alteration
❑Opening of framed cavity alone—Alterations that involve the opening of the framed caviry of a wa!!,cei/ing,or floor mus!install!he
mandatory minimum insulation value per y��i50for the altered assernblv.Fil!in Columns A—C and enler�nandatorv insulation value in Column H.
❑Replacement of entire assembly—Rep[acemeni nf an entire wa!!, ceiling, a�Jloor as.remhly reyuires the insto[lation qJ Compnnent
Packa e-D insulation vah�es in Table I51-C. Fil!in Columns A—J.
0 a Ue SUCfaCe Detalls For the furred portioned of Mass Walls see Furring Strips Construction Tablc below.
A B C D E F G H I J
Proposed s��not� Standard Values From JA4 Table
Framing � T ' kness� � ,�, Framed Continuous JA4 Proposed
Tag/ Assemb � : �', I,� ' �"{+�'� �� Assembly Assembly
ID� or T d e t�' c r uni"�"r�' -v�aln - a�e Cell Valueft U-factory
_. . �'. � .�i�+����r, � ��, ��� � -
, .;
��+�r��'���' � +q�,t' �r'�� _-",� .� i� �
�c�t � ���
�' �,, r�w�� ��=^s��,�..
�'�, � ,,.._
� :�, �E3y.�e== .,, � 5*``
? �1�9�Poi.� ..,��, �c��. � � .
Noter For jurred assemb�ltes,accountin�o�G�on�4��, aK�� - ue,,5e�Eage �4- ari, v on �� o�Y,��-alculati»g furred walls use lhe N1ass a�1d
Furrin Construction t I�b 1 tsF � "� � �� � �� ���� �_
!.For Tag/ID indicate" ��ilenh� ,�i n na �� match � butl�'u g plan.s� A, _
���o„x�� � '" ,��:e� p �
2.lndicate the Assembly Name or type:Ro d �� �F�6S�` �'s �lu �atiul�,Sjt�t�B� oors 1�,��: �dicute th � type and Size:For
Wood,Metal,Metal Bui[dings,Mass,en e � b p�� ss��'��4,� Y�ilh€"'��' �' �i �ssemb��} �` �=
'� �w� � '&� �� � , �`
?. Enter the Ihickness for mass in inches or pacing between frurn�in�men2b�rs enter; `�crr_ `'i7C:or 0�1t�rfor al!other assernbly descripGon
such as Concrete Sandwich Panel,Spandrel Panel,Logs,Str Bals Panel nnd etc.... � "'- � -
,�_
4.Based on the Climate Zone,-enter the Standard U faclor fro =a�1��+151-B, C or D Jor each diJferenl�ass�m�I��Nam '��Yr�pe.
5.Enler the Table number lhal closely resembles the proposed assemblv. � �
6. Enter the R-value that is fieing installed in[he wall cuvity or fietH�een the framing;othent�ise,enter "0".
7. Enter the Continuous Insulation R-valuelor the proposed nssembly;othenvise,enter "0".
8.Enter the row and co/umn of the U-faclor value based on Column F Table Number and enter the Assembly U./'actor in Column J
9.The Proposed A.rsembly U fuctor, Column J,must he eyual to or le,ss than the Standard U factor in Co/umn E tu coniply.
Furrin Stri s Construction Table for Mass Walls Onl I
A B C D E F G H I J K L M
Proposed Properties of Masonry and Concrete Added Interior or Exterior Insulation �
Walls From Reference in Furring Space from Reference '
Joint A endix Table 4.3.5,4.3.6 4.3.7 Joint A endix Table 4.3.13
'J rp T C � � u
vi R 4' `� U O.c� [�C v.
O C�
Assembly �<� � o o � � v o m'"� ��� �"'� Final
Mass I Name or ]A4 Table � � � ;, % � � � o '�� � � �; � Assetnbly
Thickness T e Number' ¢ > � W ,� ¢ > W U-factor�'� Comment
RegistrationNumber: 314-A0021081A-000000000-0000 RegistrationDate/Time: 05/28/201416:42:18 HERSProvider: CBPCA
2008 Residentia!Compliance Forms August 2009
Prescri tive Certificate of Com liance: Residential CF-IR-ALT
Residential Alterations Pa e 2 of 5
Project Name: Climate Zone# #of Stories
Paul Burmeister 9 1
ass and Furrin Stri s Construction ootnotes
l.Indicate the type of assembly to include;Hollow Unit Ma.ron�y Walls,Solid Unit Masonry,Solid Concrete Walls, Etc. Additional as.remblies can
e found Reference Joint Appendix JA4.
. This is the U-Factor based on the thickness of the assemblv in inches.
3. The R-value of the insulntion lo be added on the interior or exterior of the assembly.
4. The Calculated R-Value is the R-value of theJurred oul section of the nssembly.
.-6.77te Finul Assembly is culculated using Equution 4-2 or Equation 4-4of the Reference Joint Appe�idix JA4. The eyuation is the inverse of Column
added to Column 1. Column K is the invenre fi•om column J.
7.Insert the calculated U-actor value on to the D a ue Sur ace Details in Column J
FENESTRATION PROPOSED AREAS
❑ Replacing window alone—Replacement windows shal!meel the U-Factor and SHGC Value requirenrents of Component Package D in
Table IS/-C. The Total Fenestration and West-j'acingArea requirernents are not applicable.
❑Adding SOftZ or less of wlndow aCea—Newly rns[alled windows s/ia!!meet the U-Faclor and SHGC Value reguiremenls of Component
Package D in Table 15/-C.
❑Adding more than SOftZ of window area— Newly installed windows shall meet the U-Factor and SHGC Yalue and the Fenestration
Area requirements of Component Package D in Table 151-C. Complete the Altered Fenestrution Allowed Area Tcible on Page 2 ojthe CF-IR-ALT
� � � ti �� �
Fenestrat����� ����i��� �`�' �: ��s � �. � �x ���� ��� �m NFRC or Default �
(Window,Glass,AQor�or��S li ht outh,We�t ft2 ,�i;J-fac[o�'3 SNGCZ•:4 Values
� ��rs ��� �
� ,
.: „ _ �
�;�C iE
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„"�; . _�
� ,_ _ � ..e>� _ �-�n,
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S��� �� "� ��
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� -- �c� '3 ���� . �
�. �'� �y�
�'+ .���a,.. ,=�ci
�`� ..}„�K: x,:�� ;�"'��"�+�k, �i
r �c.� � �,...,-m�� �. ,a �r`.�
1.Fenestration area is the area of tota!gl �p�r ._ C�d��,�' �1ts ft�(t7n�;���ep�`� �: is less_lh�n�((1�'�t���,the fenestratio�t
area may be the glas.r area plus a "2 inc Y tn t� �rt�� e�glasa '�� � � � v ''���' �'���� � _
l.Enter vafue from Component Package D Requirements�n Table 1�S�C. a � �, �
3.Actual fenestration products installed and a,r indicated in CF�Rr',E��`V Forin.rhall be equivalent to or=huve�'�I�we�U�t�ctvr and/or a lower
SHGC value thun thut specif:ed on the CF-1R ALT Form. _
4.Submit a completed WS-3R Form i/a reduced SHGC is calculated with exterior shading.
S.I a licable at this sta e enter "NFRC" or NFRC Cer[i ied windows or are CEC "De ault"values ound in Table 116-A or B.
ALTERED FENESTRATION ALLOWED AREAS(Coinplete if inore than SOft�of fenestration is added)
A B C D E F G
Allowed Existing Fenestration Total Area
CFA of Entire %of Fenestration Area Fenestration Allowed Proposed AreaZ
Dwellin CFA Area Removed Area Added A x B E-D +C
Total Fen(s�tZation Area ZO
>
West Fenestration Area
(Required In .OS >
CZ's2,4&7-IS
1. West Fenestration Area includes west-sloping skylights and any stiylights with a pitch less than /:12.
1. West facing glazing area rentoved cannot be "counted"hvice." In order to distribute the west glazing area removed to die other orientations,
input the west glazing area removed in the Total Fenestration Area row,column D.
3.Include the Proposed Area of the West facing fenestration in both Area columns below.
4. To meet com liance,the Pro osed Area must he less than or e ua!to the Tota!Allnwed Area or BOTH the Tnta!and West Fenes[ration Areas.
Registration Number.• 314-A0021081A-000000000-0000 Registration Dnte/Time: 05/28/2014 16:42:18 HERS Provider: CBPCA
2008 Residential Compliance Forms August 2009
Prescri tive Certificate of Com liance: Residential CF-IR-ALT
Residential Alterations Pa e 3 of 5
Project Name: Climate Zone# #of Stories
Paul Burmeister 9 1
ROOFING PRODUCTS(COOL ROOFS)§ISI(n12
When the area of exterior roojsurface to be replaced exceeds more than 50%of the existing roof area,or more than 1,000 ft�,whichever is
less,the new roofing area must meet the roofing product"Coo!Roof'requirements of§I52(b)1Hi,152(b)IHii,ar 152(b)IHiii.
Check applicable alternative or exception below if the roof alteration is exempt from the roofrng product "Cool Roof'requirements.Note.•Ijany
one of the aJternatives or exception below is checked, the Aged Solar Rejlectance and Thermal Emittance reguirements jor roofing products in
,¢718(i)are not applicable.Do notfill table below.
❑Cool Roofs Not Required in Climate Zones 1-12, 14,and 16 with a Low Sloped. Less or 2:12 pitch.
❑Cool Roofs Not Required in Climate Zones 1 through 9 and 16 with a Steep-Sloped Roofs(pitch greater than 2:12)and product unit weight less
than 516/ft2.
Alternarives to§152(b)1Hi and§152(b)Hii,Steep-slope roof(pitch>2:12)
❑ insulation with a thermal resistance of at least 0.85 hr•ftz•°FBtu or at least a 3/4 inch air-space is added to the roof deck
over an attic;or
❑ Existing ducts in the attic are insulated and sealed according to§151(fl 10;or
O In climate zones 10, 12 and 13,with 1 f�of free ventilation area of attic ventilation for every 150 ftz of attic floor area,and
where at least 30 percent of the free ventilation area is within 2 feet vertical distance of the roof ridge;or
❑ Building has at least R-30 ceiling insulation;or
❑ Building has ra ' t b ' r' the attic n�,eeting requir� en $f§151(fl?; •
❑ Building has n d . , �," " ' � ,
❑ In climate zones ]0, 3 and 4 R-3 eater r deck ins ation a e vented attic.
Exception to§152(b i�H� ow slo e roo ' h� �� . _ � ��
O Building has o u the a �.�`a��
Other Exceptions � '���` + v �'�� , ..�
� � ��;a: i3� `�' .'�6 � ...
❑Roofing area co �buildm��irate,� �'��� t�uu �� ata�ls an so�� �itn� �sz � �� �t from the below Cool Roof criteria.
❑Roof construcno =t�a�h�?�e�th�'lmal t�_, t�, ��C�ie ro _�, ,emt3tane vvith a le��fx �,_, �t �s ex rri romath,e.�l�lpw�Cp91 Roof criteria.
Note:If no CRRC-1 laliel�isa-availalile��his v li nce me{�ipd�ca�`o��be use�us Ehe Ferformance Approacti�ta�sfiaw epmpliance,othenvise,
e�� '
Check the a licable bo�b�low if Exe ,��the R��tZ,�"__ 1'ro.du,,s"Cvat�R,00��R;; uirem,eut, :, �
Frp��l �� ` Aged�S4�a�r�"�� ,"X;heimal
���,.�� � ...� ,,� �, � ,,. ,� , � s
CRRC Product ID Number �'� � s� ��17/ ���- /ft � ����,C�Ci� �dilit#tance SRI
❑ ❑ C (Q� � q e., t� �n.;
� �: � ��
❑ ❑ � ❑ �a -�,��,�a.
�
❑ ❑ ❑ ❑ ❑4
❑ ❑ ❑ ❑ ❑4
❑ ❑ ❑ ❑ ❑4
1. The CRRC Product ID Nt�mbei�cun be oblained from[he Cool RoojRuting Council's Rated Producl Directory u�www.coolroafs.or�roducts/search.nho
2.Lidicate!he type of product is heing u.red for the roof top,i.e.single-ply ronf,asphalt roof,meta!ronf,etc.
. Ijthe Aged Reflectance is not avai/able in the Cool RoofRating Counci!',s Ra(ed Prodisct Direclorv then u.re the Initial Re/lectance value fi�om the same
directory and use the equation(O.l+p.7(P;nttta!—0.2)!a obtain a calculaled aged value. Where p is the Inilia!Solar ReJlectance.
4.Check box if the Aged ReJlectance is a calculated vulue using the eyuution above.
5.Culculate the SR/value by using the SR/-Worksbeet at hl�p.•//wM�w.energ}cu.gov/ti�le24/and en�er die resulling value in the SRI Colunin ubove und attuch acopy af
the SRI-Worksheet to the CF-lR.
To apply Liquid Field Applied Coatings,the coating must be applied across the entire roof surface and meet the dry mil thickness or coverage
ecommended by the coatings manufacturer and meet minimum performance requirements listed in§118(i)4. Select the applicable coating:
❑ Aluminum-Pigmented Asphalt Roof Coating ❑ Cement-Based Roof Coating ❑ Other
Registration Number: 314-A0021081A-000000000-0000 Registration Date/Time: 05/28/2014 16:42:18 HERSProvider: CBPCA
2008 Residential Compliance Form,r August 2009
' Prescri tive Certificate of Com liance: Residential CF-IR-ALT
Residential Alterations Pa e 4 of 5
Project Name: Climate Zone# #of Stories
Paul Burmeister 9 1
HVAC SYSTEMS-HEATING
Minimum Duct or Piping Configuration
Heating Equipment Efficiency Distribution Insulation Thermostat (Central,Split,
T e and Ca aci �'Z'3 AFUE or HSPF) T e and Location" R-Value T e S ace,Packa e or H dronic
Furnace, 95 AFUE Ducted, 8 SetBack Split
' 1.Indicate Heating Type(Central Furnace, Wall Furnace,Heat pump,Boiler,Electric Resistance,etc.)
2.Electric resistance heatrng is allowed only in Component Package C, or except where electrac heati�lg is supplemental(i.e.,if total capacity
<2 KW or 7,000 Btu/hr elech•ic heating is controlled by a time-limiting device not exceeding 30 minutes). See§/51(b)3 exception.
3.Refer to the HERS Yerification section on Page 4 of the CF-1 R-ALT Form for additiona!requlrements and check applicab[e boxes.
4. Indicate Type or Location(Ducts,Hydronic in Floor,Radiators,etc.)
' HVAC SYSTEMS-COOLING
Minimum
Efficiency Duct or Piping Configuration
Cooling Equipment (SEER/EER or Distribution insulation Thermostat (Central,Split,
T e and Ca acity�'z COP) Type and Location3 R-Value Type Space,Package or Hydronic)
�I AirConditio ,�- 15.2 SE�R Q ct � 8 ,� SetBack Split
:
�
l.Indlcate Cooling Tyjz_ ��'�eud'pump, �� o tc � � � '� �
2.Refer to the HERS ��,�5��� ..�o ��" 1 . -T ���- t 1 ' �.' oxes.
w,,,,���
� 3.Indicate T e or � ���Duc�t�,�' .�� r�� �loor adiators,etc.
���''I �.:.�3��• ' � �=�' .a s� Y� �y
,-
" � ,
�', WATER HEA'�' r,._ �,,� ,.��� «�� ��:: � _
��
, 3. �, a
... ���..F ' `_ ���.�.. � 7r .i�' ""'
� List water heaters an�'1;��,t,��`��� � ��t wate j" ' �dr'�rs anr�h _""�� ,�'pace heating. I u�_ M�'+E7�;DHW heaters must be
g¢s or propane fired,an��ri�ceed Ha���;,� �sulati �� . DHW h r�� hen�S`�, €r:pn all underground
,�
I� hot waler i es is re uired in all com one, � �
-- +�� a��q�.
r�
� �� � r'`��� ���� _„ ��� � , ��; External Tank
' Wafer Heater Type/Fuel Distribution Type � um�ei�In - � �gy Fa�t�r-; Insulation
Type� (Standard,Recirculating)� � �i System Capacity(gal) �s� ��i��� R-Value�
,�„d '��' �" ^:tiF
1.Indicate Type(Storage Gas,Heat Pump,Instantaneous,etc.) �
2.Recirculating systems serving multiple dwelling units shall meet the recirculation reguirements of�I50(n). The Prescriptive requirement.r do
not allow the installation of a recirculating water heating system for single dwelling units.
� 3. The external water heatin tank and i es shall be insulated to meet the re uirements o I50 ).
SPECIAL FEATURES The enforcement agency should pay special attention to d:e Special Features specified in this checklist below.
These items ma re uire written 'usti icatinn and documentation and s ecial veri ication.
NEW ROOF ASSEMBLY-Radiant Barrier
Ttie radiant barrier re uirement of§151(fl2 does not a l to roof alterations.
Slab Edge(Perimeter)Insulation 0 YES 0 NO
YES:In Climate Zone 16 in Component Packages D,R-7 insulation is required.
Heated Slab Insulation �YES 0 NO
l'ES:Slab ed e insulation re uired for all heated slabs in all Climate Zones. See details in Table 118-A of the standards.
Raised Slab Insulation 0 YES 0 NO
YES:In Climate Zones l,2, l l, 13, 14& 16,R-8 insulation is re uired;in Clima[e Zones 12& 15,R-4 is re uired under com onent Packa e D.
Thermal Mass
To obtain Com liance Credit for the installation of thermal mass,use the Performance A roach.
RegistrationNumber: 314-A0021081A-000000000-0000 RegistrationDate/Time.• 05/28/2014 16:42:18 HERSProvider.• CBPCA
2008 Residential Compliance Forms Augu,st 2009 I
Prescri tive Certificate of Com liance: Residential CF-IR-ALT
Residentia[Alterations Pa e 5 of 5
Project Name: Climate Zone# #of Stories
Paul Burmeister 9 1
HERS VERIFICATION SUMMARY The enforcement ugency should puy speciul attention to the HERS Measures specified in this
checklist helow. A completed und signed CF-4R Fnrm for all the meusures specifed shall he suhmitted to the huilding in,spector hefore finul
ins ection.
Duet Sealing&Testing HERS vertfication is required for this meu.rure.
�YES 0 NO YES:In Climate Zones 2 and 9-16,if more than 40 linear feet of new or replacement ducts are installed in unconditioned
space,the ducts are to be sealed per§152(b)1Dii and the newly installed ducts are to be insulated per§151(�10.
❑ EXCEPTION:Existing duct systems that are extended,which are constructed,insulated or sealed with asbestos.
�YES 0 NO YES:In Climate"Lones 2 and 9-16,if the existing space-conditioning system(HVAC equipment and ducting)is replaced,the
ducts are to be sealed per§152(b)1 Di.
0 YES �NO YES:In Climate Zones 2 and 9-16,if the existing HVAC equipment is replaced(including the replacement of the air handler,
outdoor condensing unit of a split system,cooling or heating coil,or the furnace heat exchanger)the ducts are to be
sealed per§152(b)1 E.
0 EXCEPTiON:Duct systems that are documented to have been previously sealed confirmed t6rough HERS
verification in accordance with procedures in the Reference Residential Appendix RA3.
❑ EXCEPTION:Duct systems with less than 401inear feet in unconditioned space.
❑ EXCEPTION:Existin duct s stems constructed,insulated or sealed with asbestos.
Refrigerant Charge-Split System HERS veriftcation is required for lhis measure.
0 YES �N ES: �mate Zones€2 and wh� th e�cistin HV e ui m t is re laced including the replacement of the air
�$l � ��i e � �t����it A��O� t�,' '� �t n��#l,or the fumace heat
��� „�ex�;�tt���gc a re � � �c e measure ent sh'� verified er§�� 2(b)1F. � �„� ,�
Central Fan Int���w � � ��e� - � ����`� �� �� ��, ��- _
The venCilation re ��enpett of� 1�SQ - �b �'� �I to existm residential homes.
Ducted Split Sys�k6]lllrs-�Air Condiriop�L'S�AA C�����- �S: 8 9w I� �� i . hb " required jor rhis measure.
�YES �N 4 �S: Climate Zc��1 - Q g�� ; �tt�E ��t���p���R 52(b� � �HVAC equipment and ducting)is
�` tl�e.�-�t � fan � s{i 1 o riieet�;h��P�"�ut�ne�ts of '151(�7B.
a1�be ve
�� `�W� � �`; a,' �;
� x _ : ,..
Documentation Author's Declaratio� _ t�m n, _ . ,�..,.�,��„.'
• I certi that this Certificate of Com ��e��a 3�U�,;iis�acet��..,�and -� �t���,. n,,„ ���"�
Name: �'��;;;- Signature: �' "�+��
Gary Alderete ��u� Gary Alderte �� ,;�� �r.
, � ��, �
� - �- �.��,,.
Company:Cypress Heating&Air Conditioning Da�°e: 5/28/2014
Address: If Applicable�CEA or�CEPE
547 S.Loraine Ave
(Certification#):
City/State/Zip:Glendora California 91741 Phone: 6269639810
Responsible Building Designer's Declaration Statement
• I am eligible under Division 3 of the Califomia Business and Professions Code to accept responsibility for the building design identified on
this Certificate of Compliance.
• I certify that the energy features and performance specifications for the building design identified on this Certificate of Compliance conform
to the requirements of Title 24,Parts 1 and 6 of the California Code of Regulations.
• The building design features identified on this Certificate of Compliance are consistent with the information provided to document this I
building design on the other applicable compliance forms,worksheets,calculations,plans and specifications submitted to the enforcement ,
a enc for a roval with this buildin ermit a lication. li
Name: Gary Alderete Signature: Gary Alderte '
Company: Date:
Cypress Heating 8 Air Conditioning 5/28/2014
Address: License:
547 S.Loraine Ave 302865
Ciry/State/Zip: Phone:
Glendora California 91741 6269639810
For assistance or questions regarding the Energy Standards,contact the Energy Hotline at:I-800-772-3300.
RegistrationNumber: 314-A0021081A-000000000-0000 ReglstrationDate/Time.• O5/28/201416:42:18 HERSProvider: CBPCA
2008 Residential Complianee Form,s August 2009
�.
CERTIFICATE OF FIELD VERiFICATION AND DIAGNOSTiC TESTiNG CF-4R-MECH-25
Refri erant Char e Verification-Standard Measurement Procedure (Pa e 1 of 5)
Site Address: Enforcement Agency: Permit Number:
21226 E.Davan St Diamond Bar CA 91765 Diamond Bar,City of 14-3669
Note:IJinstallation of a Charge Indicator Display(CID)is utilized as an a[ternative to refrigerant charge verification for
compliance, a MECH-24 Certificate(instead of this MECH-25 Certificate)should be used to demonstrate compliance with
the refrigerant charge verification requirement. TMAH and STMS ar•e 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 dwel[ing as applicable.
Temperature Measurement Access Holes(TMAH)and Saturation Temperature Measurement Sensors(STMS)
, Procedures for installing TMAH are specified in Reference Residentia!Appendix RA3.2. If refrigerant charge verification
is required for compliance, TMAH are also required for compliance. STMS are only requiredlor 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
System Location or Area Served
1 ❑ s pNo 5/16 inch(8 mm)access hole upstream of evaporative coil in the return plenum and
�� a e t' �
2 ❑Ye p�o � n a c o do t a�m of a`or i� i�'in the supply plenum
_:,;.� i�� _ - ;� atad a el � .F� � ctDon�.� . �
__: ,.�; �d ��
Yes to 1 and�e�f����ass. ����. � � �� ����� �_�Enter Pass or Fail ���� � �� ❑Pass��� ��� ����✓ ❑Fail
� ' �,
STMS-Seu �! ,,t� the E�a ora�� ��,�€ ,, �
� i�,.
,
_��
};..::: ��,,. � ��� -� ,�x�._
.. . . .�:. , �,.,.„ �- ,�� ,, _ e
Sys[em Narri or ent%fcab�l� , - _
a�� r;n.�' r «i r, 5"�E.
� ������� '�` f��n '.. tall�cl�,ti � � 'nstalY� 'a ' rdm�"�`�to man `"� rer's
� �y s
3 ❑Yes �No � ' � s r�r is�ns 1�led e s s�c �''��ns�a praved byx"t e Executive
,
i ect . _ �
The sensor wire is ��etminated with a standard mini�� ing suiC2tta�le or��connection to a
4 ❑Yes ONo digital thermo��her'��I'he sensor mini plug is accessi`�b3e.a��r�inst�lfi�'g 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 •� ❑Pass ✓ ❑Fail
N/A if STMS are not applicable. Otherwise enter Pass or Fail
STMS-Sensor on the Condenser Coil
System Name or ldentification/Tag
The sensor is factory installed,or field installed according to manufacturer's
6 ❑Yes ONo 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 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 ✓ ❑Pass ✓ ❑Fail
N/A if STMS are not applicable. Otherwise enter Pass or Fail
, RCglSll'ClllOri NU»tbCl': 314-A0021081A-M2526933A-M25A Registration Date/Time: 09�24/2014 19:57:14 HERS Provider: csPcn
2008 Residential Compliance Forms August 2009
�/ I
CERTiFICATE OF FiELD VERIFiCATION AND DIAGNOSTiC TESTiNG CF-4R-MECH-25
Refri erant Char e Verification-Standard Measurement Procedure (Pa e 2 of 5)
Site Address: Enforcement Agency: Permit Number:
21226 E.Davan St Diamond Bar CA 91765 Diamond Bar,City of 14-3669
Standard Charge Measurement Procedure(for use if outdoor air dry-bulb is above 55°F)
Procedures for determining Refrigerant Charge using the Standard Cha�ge Measurement Procedure are availahle in Refer•ence
Residential Appendix RA3.2. As many as 4 systems in the dwel/ing can be documented for compliance using this form. Attach an
additiona!form(s)for any additional system.s in the dwe!ling as applicable.
• The system should be installed and charged in accordance with the manufacturer's speciJications before starting this procedure.
• The system must meet minimum airflow requirements as prereyuisite for u vulid refrigerant charge test.
• If outdoor uir dry-fiulb is 55°F or below,the installer must use the AI[ernute Charge Meusurement Procedure.
S ace Conditionin S stems
System Name or identification/Tag
System Location or Area Served
Outdoor Unit Serial#
Outdoor Unit Make
Outdoor Unit Model
Nominal Co � ' Btu/hr�,, � ,�,
��
Date of Veri icat '
, _ , � � w ��� �
� ��� _�.....�. �._ � � ' ����. �
� , `.` � _�. ��
Calibratio„of��1 nosh�C T�'�tr ,
Date of Ref�i�'ant Gauge Calib '�� � �-��� �� (must be re-calibrated monthly)
���
.x =_ -. : ,,,,� =� �
Date of Therni�cou�l�C�ai�'�atio � =mnsf be .e=caTibrated monthly)
� �
� �::�_
,:�
Measured Tem eratures °F •• ' ;� �
� �- ��. ��- � �. �
System Name or ldentification/Tag � ,� p, ;
�. � r,:,�
�y,�r ;�
Supply(evaporator leaving)air dry-bulb -��
temperature(Tsu I �db)
Return(evaporator entering)air dry-bulb
temperature(Tretum,db)
Return(evaporator entering)air wet-bulb I
temperature(Treturn�wb) ��
Evaporator saturation temperature
�Teva oraton sat)
Condensor saturation temperature
�Tcondensor�sat)
Suction line temperature(Tsuccion)
Liquid Line Temperature(T�;y,,;d)
Condenser(entering)air dry-bulb
temperature(Tcondenser db)
� - - - . CBPCA �I
RCgISIY[lllOri N1QriFJCI': 314 A0021087A M2526933A M25A Registration Date/Time: 09/24/2014 19:57:14 HERS Provider:
2008 Residential Complianee Forms August 2009
✓
CERTIFICATE OF FiELD VERiFICATION AND DiAGNOSTIC TESTiNG CF-4R-MECH-25
Refri erant Char e Verification-Standard Measurement Procedure (Pa e 3 of 5)
Site Address: Enforcement Agency: Permit Number:
21226 E.Davan St Diamond Bar CA 91765 Diamond Bar,City of 14-3669
Minimum Airflow Re uirement
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-Tsupply,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. eme s�r ment,if b�tween � �
-4°F and-1° �',il �, �',� �. 3 � �
Note: Tem er �ture li t od, ��u� "v�i � ���� � li � 1�ir Q� t;�s ��,�e � � one o the
air,low mea . m . proe�zlux � ' �� �r��e �R ��ti p�du2� . .�'�it�dr�l�if6�l������ ���flow s ',
�� �
measured, t �t�zl�e must�`e egu rerrt"� an�th�Calts�tl�r�"�d Min' ' ow Reguirement i�a the table below. ��
����,;��� � �ti��:-,� r��,- � ����
Calculated inimum Atr'�f'tc► ii men :�,�' y��' - ominal'�Goa" ` Cap�,, (ton) X,300(cfm/ton)
�,�'
� �.�- � ��a.�
���
�-���: '��.,d6
System Name or ldenrification/T ��
, , __
�
,� �s ,� ;��
• '�a �.J,� �,�� . , ,�
_ �,� � � R
Calculated Minimum Airflow �� �, ;� �
Re uirement CFM '� �` ' "
q ( ) ' ��, - � �v'=
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 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—Teva orator 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
-6°F and+6°F Enter Pass or Fail
� RCg1SlYQ1lOri Nilril62Y: 314-A0021081A-M2526933A-M25A Registra[ion Dale/Time: 09/24/2014 19:57:14 j�ERS Provider: cePcn
2008 Residential Compliance Forms August 2009
CERTIFICATE OF FIELD VERiFiCATiON AND DiAGNOSTiC TESTiNG CF-4R-MECH-25 I
Refri erant Char e Verification-Standard Measurement Procedure (Pa e 4 of 5)
Site Address: Enforcement Agency: Permit Number:
21226 E.Davan St Diamond Bar CA 91765 Diamond Bar,City of 14-3669
Subcoolin Char e Method Calculations for Refri erant Char e Verification. This rocedure is re uired to be used
g g g g P 4
for thermostatic expansion valve(TXV)and electronic expansion valve(EXV)systems.
System Name or ldentification/Tag
Calculate: Actual Subcooling=
, Tcondcnscr sat—Tli uid
Target Subcooling specified by
manufacturer
Calculate difference:
Actual Subcooling—Target Subcooling=
System passes if difference is between
, -4°F and+4°F 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 Na e ,_ � ,� �
Calculate: Actual�Superh�ak — � �
,
.� ;,, : ;�. � -,,p k -�� ..: . ', , � .
Tsuction —T " sa�--��.�':�,
_ .
Enter allowa��r['��gu erheat r"arige
r a��M� „ � _
manufactur""- �sp�cifications(or se �����g 9� i"'` � � � ��°�
�w�
��
between 3° arid'. °F if.m �'�� ��T
�._
. . �
s ecification � a a[��a�T.� �� ` � � ���� ��: � �".,
� ,„�ti - � �. :, ,� �
System passes r_ � ��up"�'chea �iin ��,��" ��"�� - _ �__ �� � � -
the allowable superheat range ��; ^a� " T` �`
�,�< <r��� ���,a' �°�;�� ti
Enter Pa 8 ��a �� �= �__�', ,
_ _ -
_� �
;.
,. o
__ �. �,� �� -,�,-;
RCglSlrallOri Ni[7I16C/'.' 314-A0021081A-M2526933A-M25A Registration Date/Time: 09/24/2014 19:57:14 HERS Provider: csaca.
2008 Residential Compliance Forms August 2009
- - - — - �
. � �
CERTiFiCATE OF FIELD VEWFICATION AND DIAGNOSTIC TESTING CF-4R-MECH-25
Refri erant Char e Verification-Standard Measurement Procedure (Pa e 5 of 5)
Site Address: Enforcement Agency: Permit Number:
21226 E.Davan St Diamond Bar CA 91765 Diamond Bar,City of 14-3669
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. 1f corrective actions were taken,all
a licable verification criteria must be re-measured and/or recalculated.
System Name or ldentification/Tag
System meets all refrigerant charge and
airflow requirements. Enter Pass or Fail
� � ��� `� �, 3
- _ �� � � ��� � � '
--� �
� � ��
_ � � �.� � �-
� i �, '� �3�'R � a F�,^ II
,�,���, .,,�'' ���� � �. ,�, _ � �,"t 7 �
- ���
r�
DECLARATION STATEMENT �. =�
���...'
• I certify under penalty of perjury ���� tf� a � e Sta e o�'' d�i�$a���a,��� 'tt�� � � � t prof�ided�n�t}tis�ftirin�t�true and correct.
. I am the certified HERS rater who performed the vertft tt n services identified and reported pn tl�is�certi c�. �"C�ponsible rater).
• The installed feature,material,com onent,or manuf tured,iievice re uirin HERS verificatio at�' { �' this certificate
p ��� 9 S '����,m , ;: ,�
(the installation)complies with the applicable requirements m Reference Residential Appendices RA2 and RA3 and the requirements
specified on the Certificate(s)of Compliance(CF-1 R)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)
Cypress Heating 8 Air Conditioning
Responsible Persods Name: CSLB License:
Gary Alderete 302865
HERS Provider Data Re ist Information
Sample Group#(if applicable): ❑ tested/verified dwelling 0 not-tested/verified dwelling
314-0210 in a HERS sample group
HERS Rater Information
HERS Rater Company Name:
Michael Flynn
Responsible Rater's Name Responsible Rater's Signature
Michael Flynn Michael Flynn
Responsible Rater's Certification Number w/this HERS Provider: Date Signed:
1095825 9/24/2014
RCgiSll'allOq Ntl»tII2Y: 314-A0021081A-M2526933A-M25A Registration Date/Time: 09/24/2014 19:57:14 HERS Provider: CBPCA
2008 Residential Compliance Forms August 2009
CERTIFICATE OF FiELD VERIFICATiON AND DiAGNOSTIC TESTING CF-4R-MECH-2l
D'uct Leaka e Test—Existin Duct S stem (Pa e 1 of 2)
Site Address: Enforcement Agency: Permit Number:
21226 E.Davan St Diamond Bar CA 91765 Diamond Bar,City of 14-3669
Enter the Duct System Name or ldentification/Tag:System 1
Enter the Duct System Location or Area Served:House
Note: Submit one Installation Certificate for each duct system that must demonstrate comp[iance in the dwelling.
This installation certificate is required for compliance for alterations and additions in existing dwellings to space
conditioning systems and duct systems.
Note: For existing dwellings, a completely new or rep[acement duct system can also inc/ude existingparts of the origina/
duct system (e.g., register boots, air handler, coil,plenums, etc.)if those parts are accessible and they can be sealed. For a
completely new or replacement duct system installed in an existi�2g dwelling, use the Installation Certificate titled "Duct
Leakage Test—Completely New or Replacement Duct System."
Duct Leaka e Dia nostic Test—existin duct s stem
Select one compliance method from the following four choices.
❑Option 1.Measured leakage less than 15%of Fan Airflow.
❑ Option� � �����'d � �� _ E�" 'P`� °� �
❑Option 3. $� , ,�_' r ` . �� .. . � � . a�� ������ . �
❑Option 4.' at accessib e e� �sin m i� test and RS rater mus eri-�y
;..,�
Note: (Opt�ct � rriu,st be attem�� � �� ��r. �"-���'� ' OpCia � "� "�
�� ��v; �� �„ � �,
❑ Coolin sOst m method: g Za� �II ne o � �"'v,%�"g three c ° ' on methods.s x�,., � '"�'
�
"�^+� ' .s�=�'Airt� - � � ' � H„
g Y �, �' ��Op�,�� � F�VI`
❑Heating system method: 21.7 s Heatiz� u �apa = �. �
' 1�f, '_' � �� g��' �t _ �
_ Ary.�ay' wpdu�. ' c t-�
�'x �
❑Measured system airflow using RA3 3 airflow te ��p�'q�edures: CFIV� �;� � ��,
Option 1 used then:
Allowed leakage=Fan Airflow x 0.15= CFM
� Actual leakage= CFM
Pass if Actual leaka e is less than Allowed leaka e ❑Pass❑ Fail
Option 2 used then:
Allowed leakage=Fan Airflow x 0.10= CFM
2 Actual leakage to outside= CFM
Pass if Actual leaka e to outside is less than Allowed leaka e ❑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 reduction /Initial leakage )x l00%_%Reduction
Pass if%Reduction>60% ❑Pass�Fail
Option 4 used then:
All accessible leaks repaired using smoke test. HERS rater must verify(No sampling).
4
Pass if all accessible leaks have been sealed usin Smoke Test ❑Pass ❑Fail
Registrafion Number: 314-A0021081A-M2126932A-M21A Registration Date/Time: 09124/201419:45:58 HERSProvider: CBPCA
2008 Residential Compliance Forms August 2009
, � � •
CERTIFICATE OF FiELD VERIFICATION AND DiAGNOSTiC TESTiNG CF-4R-MECH-21
D1�ct Leaka e Test—Existin Duct S stem (Pa e 2 of 2)
Site Address: Enforcement Agency: Permit Number:
21226 E. Davan St Diamond Bar CA 91765 Diamond Bar, City of 14-3669
❑ Outside air(OA)ducts for Central Fan Integrated(CFI)ventilation systems,shall not be sealed/taped off during duct
leakage test' u ts utili ntr e etorized d e s,th� e onl en O ventilation is required to
meet ASHR�S���,� p��se �l ' �g�it� . t�e closed position
during duct leaka e��'"es�ing. . ��, � �
❑ All suppl, �� r�� e ister "tto 1 �� i� k��� " ���` �._�..� .. ._�aPPlies to
duct leakag ��iance op'o�i� '�,'�, "��ge ��ct�on b 60°/a an,d option 4 fix all accessible leaks)described above.
,� '�ws _ �•tR� ��h'�
�. 3; _� � � 3,�
❑ New du'` lations cannoC" �ti�s� ��u 5;' '��� ���s in lieu of ducts.
� � ,
' � , ��'a v'w,,w�E 4R,� . . .
�� . �r� •
❑ Mastic :: a�ds� u�� �"� � in co�� � ,�„"th clo a, � rubber a esive,�d�et�tape t���s��al leaks at all new
duct connectio '' '��
DECLARATION STATEMENT
. I am t e certifi d HERS rater ho erformed the ver�fica�on servi�' p �'}� ��s true and correct.
• �m� , toyidad�on hi�+fo�t
p �denUfied and re ortedron t�i•ce Kficate`r�sponsible rater).
• The installed feature,material,component,or manuf���device requiring HERS verificafion��at's identi�,_��qp 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-1 R)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 requiremen[s specified on the Certificate(s)of Compliance(CF-1 R)approved by the
enforcement agency.
Builder or Installer information as shown on the installation CerNficate CF-6R
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
Cypress Heating 8� Air Conditioning
Responsible Person's Name: CSLB License:
Gary Alderete 302865
HERS Provider Data Re ist Information
Sample Group#(if applicable): ❑ tested/verified dwelling � not-tested/verified dwelling
314-0210 in a HERS sample group
HERS Rater Information
HERS Rater Company Name:
Michael Flynn �
Responsible Rater's Name Responsible Rater's Signature
Michael Flynn Michael Flynn
Responsible Rater's Certification Number w/this HERS Provider: Date Signed:
1095825 9/24/2014
Registration Number: 314-A0021081A-M2126932A-M21A Regish•ation Date/Time: 09/24/2014 19:45:58 HERSProvider: CBPCA
2008 Residential Compliance Forms August 2009
INSTALLATION CERTIFICATE CF-6R-MECH-04
S ace Conditionin S stems,Ducts and Fans Pa e 1 of 2
Site Address: Enforcement Agency: Permit Number:
21226 E.Davan St Diamond Bar CA 91765 Diamond Bar,City of 14-3669
Space Conditioning Systems
Heating Equipment
Duct
Efficiency Location
Equip (AFUE, (attic,
Type ARI #of etc.)�'3 crawl- Heating Heating
(package- CEC Certified Mfr.Name Reference Identical (>_CF-1R space, Duct Load Capacity
heat um and Model Number Number' S stems value)° etc.) R-value (Btu/hr) (Btu/hr
Fumace Lennox e1195uh110xe60o-04 1 95 House 8 0 110000
.@._._. �., � ..... :� 1�.�
�.'
. . . . .� . . � �
I � ...� _ : �': :. �, �. �.� � _ �'', . . :, ' . . . .
�_ ■: �
�?�.....� .�,.,..A�„-.,.,�. �'�. ., a�. +w wu�,. ..w:. .- .;. .�
.,.��� ..... „ _. -
Cooling Equip�,,�� ��'��� ����� �� � ;�� _ �� �" �� ���� �� ��� ,.
.;.
,
� �� c
a�" �
��
,
E ui �i � ��' ..��: ��
4 P �,
TYPe � R) (attic, -
(Package �� y�� �� #of ,,; - �ya"�oa i�g Cooling
heat CEC Certified Mfr. ''�'��� - � ' ��;�'r��°� �tt��a��„ �,_ � � Due ��, � ��d Capacity
��a , �� �
um and Model Num . �uu1 ,StemS,� uC� _: ;e. . ,�- �L-W alue EB�i�hr (Btu/hr
AirConditioner Lennoxxcl4-042-230-04 � ��� s �1- 15. - ouse . �+'�8 � µ�,�h,D 42000
���'�. ,�, ;�4 .
�, '
1.If project is new construction,see Footnotes to Standards Table 15/-B and Table /S1-C for duct ceiling ahernative
compliance.
2.ARI Reference Number can be found by entering the equipment mode!number at http://www.arrdirectory.org/ari/ac.php#
3.Listed e�ciency on this page must be greater than or egual(>)to the value shown on the CF-!R form.
4. When CF-IR is reference it is also applicable to the CF-IR, CF-IR-AA or CF-IR-ALT
ALL BOXES MUST BE CHECKED TO BE A VALID FORM
❑'' §110-§113:HVAC equipment is certified by the California Energy Commission.
''❑ §150(h):Heating and/or cooling loads calculated in accordance with ASHRAE,SMACNA,or ACCA.
� §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-B and includes a vapor retardant or is enclosed entirely in conditioned space.
2008 Residential Compliance Forms August 2009
INSTALLATION CERTIFICATE CF-6R-MECH-04
S ace Conditionin S stems,Ducts and Fans Pa e 2 of 2 '
Site Address:. Enforcement Agency: Permit Number:
21226 E.Davan St Diamond Bar CA 91765 Diamond Bar,City of 14-3669
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-42 or enclosed entirely in conditioned space. Openings shall be sealed with mastic,tape
or other duct-closure system that meets the applicable requirements of UL 181,UL 181 A,or UL 181 B or aerosol �
sealant that meets the requirements of UL 723. If mastic or tape is used to seal openings greater than 1/4 inch,the
combination of mastic and either mesh or tape shall be used;and
0 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 far conveying 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.
❑'' 2D.Joints and seams of duct systems and their components shall not be sealed with cloth back rubber adhesive
duct tapes unless such tape is used in combination with mastic and draw bands.
❑'' 7.E�chaust fan systems have back draft or automatic dampers.
❑`' 8.Gravity ventilating systems serving conditioned space have either automatic or readily accessible,manually
operate � � ' ;� , � ` � "
❑'' 9.Protec Qz�z�a�.i�usulati �la'� shall be prote d from�damag including that c�,ue tQ s,�nlight,moisture,
equipme � en�u�""iCC��d ��z� e ot -� � ��i �� �oating that is
water r ndp� ' `' g from solar radiation that can cause degradation of the material.
,��r: �.*
❑� 10 le ducts cann ' ��
'�,�'i ;:
�� � �
���' ���� � A
n T w'^"::-'. ;r� � � ... 5 5 ��
�
E �
, y �
� �� � �
�� ;4.
3�i'f` µ � ��r� � �e
� �3� � �
..�_ _ �"
ir6
� �'d 11� � �.« �+
� M':e PA�g� a'� m'
....��Y��v�''�. ,E E�� _ �.-,, ,_.«-_..
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 reviewed a copy of the Certificate of Compliance(CF-iR)form approved by the enforcement agency that ide�tifies 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.
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
Cypress Heating 8 Air Conditioning
Responsible Person's Name: Responsible Person's Signature:
Gary Alderete Gary Alderete
CSLB License: Date Signed: Position With Company(Title):
302865 9/23/2014 Sales Manager
2008 Residential Compliance Forms August 2009
�
INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS
Duct Leaka e Test—Existin Duct S stem Pa e 1 of 2
Site Address: Enforcement Agency: Permit Number:
21226 E.Davan St Diamond Bar CA 91765 Diamond Bar,City of 14-3669
Enter the Duct System Name or ldentification/Tag: System 1
Enter the Duct System Location or Area Served: House
Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the dwelling.
This installation certificate is required for compliance for alteration.r and additio�as in existing dwellings to space
conditioning systems and duct systems.
Note: For existing dwellings, a completely new or replacement duct system can also include existing parts of the original
duct system (e.g., register boots, air handler, coil,p[enums, etc.)if those parts are acces,sihle and they can be sealed. For a
completely new or replacement duct system installed in an existing dwelling, use the Installation Certificate titled"Duct
Leakage Te.rt—Completely New or Replacement Duct System."
Duct Leaka e Dia nostic Test—Existin Duct S stem
Select one compliance method from the following four choices.
0 Option 1.Measured leakage less than 15%of Fan Airflow.
❑Option �. � ��� � '_' id � ��� f ;A� � � , � � � ����; � �'' �
d
' ❑Option 3.R'ndu�ce leakag , ' r ,� c�i�� _ � �t' a �] � * �
��.�
� ❑Option .��a 1 acces i e le � u��� t��� test,ar�d �-°1�S�ater�nust v��_.
Note:(Opt st be e �t 'u�'" � 1�0 }�,�;,, h �
��,.� � - ��
�:i� :, �r--:s����.,
m. - t _� .
Determine no���' �l�au Ai�lo ' ipg ne o � � �ll�mg t1�re �
�„ ��C„F on methods.
�. �
� �' ,,
�Cooling system method: Siz s;�'�u {�iI ' '�,,.°, ��� - �'� � '�
❑Heating system method: 21.7 � eat�g `uCpu apa����. � r�� �� �'° �
_ �4 '
❑Measured system airflow using RA33 airflow t t� ' edures: CFMg, ���� �;� �;'.
� �
Option l used then:
,m„ � _w.W.:�
Allowed leakage=Fan Airflow �aoo x 0.15= 210 CFM
1 Actual leakage= � CFM
Pass if Actual leaka e is less than Allowed leaka e �Pass�Fail
Option 2 used then:
Allowed leakage=Fan Airflow x 0.10= CFM
Z Actual leakage to outside= CFM
Pass if Actual leaka e to outside is less than Allowed leaka e ❑Pass❑Fail
Option 3 used then:
Initial leakage prior to start of work= CFM
Final leakage after sealing all accessible lealcs using smoke test= CFM
3
Initial leakage -Final leakage =Leakage reduction CFM
(Leakage reduction /Initial leakage )x 100%_°/a Reduction
Pass if%Reduction>60% ❑Pass❑Fail
Option 4 used then:
All accessible leaks repaired using smoke test. HERS rater must verify(No sampling).
4
Pass if all accessible leaks have been sealed usin Smoke Test ❑Pass OFail
�
Registration Number: 314-A0021081A-M2126932A-0000 Registration Date/Time: 09/24/2014 18:53:56 HERS Provider: csPca
2008 Residential Compliance Forms August 2009
. i
INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS
Duct Leaka e Test—Existin Duct S stem Pa e 2 of 2
Site Address: Enforcement Agency: Permit Number:
21226 E. Davan St Diamond Bar CA 91765 Diamond Bar, City of 14-3669
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 62.2,and close when OA ventilation is not required,may be configured to the closed position
during duct leakage testing.
0 All sup � � � ��? '- � �lf� liance—applies to
duct leakage o 1� e b�' 1 a a re c i n }�` 0�/�.�opf� n 4��x a ac ess�rbl�e ks escribed above.
� New duc :.� gtiQns c . b� _ �� ���s��tf,vttmi : � ��'� � .
�� .
0 Mastic �� w bands must � � ',�r'� t#�t�?,'� ith„��'"�i�b�c esive duct tape to seal leaks at all new
� ,;, i�;�,.
� ;• �.
duct conne „�. �
__ � ,� ,,�, �
,. ,
„�, �tx= �a,.s
�. '. 3�6 4'.'..
� � i
DECLARATIO ; ��t'� �NT� �� `�"� '�
.
��::-
i n '° true and correct.
I I certify under penalty of perjury tate Of Ca' orttia, o Vn v de o thts fo i�.
• i am eligible under Division 3 of � afessions Cpde ts� c ""�q�z iI`. for cons : c�ott;or an authorized
representative of the person responsible for constructi4n responsib e person).
• I certify that the installed features,materials,compoa ntsx o�'manufactured devices identified�on i�certrf ate�tlte installation)
conforms to all applicable codes and regulations,and t►e'nstallation is consis[ent with the plans arid specificati0n pproved 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 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.
• I reviewed a copy of the Certificate of Compliance(CF-1 R)form approved by the enforcement agency that identifies the specific
requirements for the installation. I certify that the requirements detailed on the CF-1 R 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 l,2010,for all low-rise residential buildings.
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
Cypress Heating &Air Conditioning
Responsible Person's Name: Responsible Person's Signature:
Gary Alderete Gary Alderete
CSLB License: Date Signed: Position With Company(Title):
302865 9/24/2014
Is this installation monitored by a Third Party Quality Control Name of TPQCP(if applicable):
Program(TPQCP)? ❑Yes �No
Registration Number: 314-A0021081A-M2126932A-0000 Registration Date/Time: 09/24/2014 18:53:56 pERSProvider: CBPCA I
2008 Residential Compliance Forms August 1009
INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS
I Refri erant Char e Verification-Standard Measurement Procedure Pa e 1 of 5
Site Address: Enforcement Agency: Permit Number:
21226 E.Davan St Diamond Bar CA 91765 Diamond Bar,City of 14-3669
Note:If installation of a Charge Indicator Disp[ay(CID)is utilized as an a[ternative to refrigerant charge verification for
compliance, a MECH-24 Certifccate(instead of this MECH-25 Certificate)should be used to demonstrate compliance with
the refrigerant charge verification requirement. TMAH and STMS are not required for compliance, when a CID is:�tilized
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 for installing TMAH are specified in Reference Residential Appendix RA3.2. If refrigerant charge verification
is required for compliance, TMAH are also required f'or compliance. STMS are only reguired for cnmpletely 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 SyStem 1
System Location or Area Served House
1 s ❑No �; 5/16 inch�8 mm �ccess hole upstream of evaporative coil in the return plenum and
�
a t re
2 �Y o � � ch m acce �e downstrea of evaporative�coil ►}�the supply plenum
az�d ed �r�i' '� �'i ct' �
_ ��: .����. . ,• '
�„__� �.� : � - �_ _ . ._�� _._._� _.
Yes to 1 an ' pass. �-�--�', „�, .,,��� ,�nter Pass or Fail ✓ 0 Pass ✓ ❑Fail �
_.��,��s
��.
� . �� _.,:�.e� �Li��' '�
__ � '.rV _= . . ..�
STMS-Sensor�p�►the E�a �a�_� �' __ � __W
�
System Nam ' � � ��
�'d�itt�CEit14 ; � ���LiJ ` � r','p r�
v
_-.
. -.�
� :€
� �� �._.... 3�i. eik
� 's a�tor)?�nsEal��,Q �� �` s e - rding tp anufa� rer's
�¢, Po�,��, �
x- �
3 ❑Yes ❑No � �t ", �s d.'�i ica �p�ro � � �e Executive
r ��
Director. � - �"'�" �
� � _
The sensor w is>ten�ninated with a standard mini pl g s�u tabl o� Qnnection to a '
4 ❑Yes ❑No digital thermo�`''""The sensor mini plug is access�le'�tv he ins�'al�ing 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 13 degrees F I
Yes to 3,4,and 5 is a pass. Enter � �y N/A ✓ C5 Pass ✓ ❑Fail '
N/A if STMS are not applicable. Otherwise enter Pass or Fail
STMS-Sensor on the Condenser Coil I
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 IOYes ONo 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 ❑IYes JNo The sensor measures the saturation temperature of the coil within 13 degrees F
Yes to 6,7,and 8 is a pass. Enter � �N/A ✓ ❑Pass ✓ ❑Fail
N/A if STMS are not applicable. Otherwise enter Pass or Fail
RCglSIYAIIOri NUIY1627': 314-A0021081A-M2526933A-0000 Registration Date/Time.• 09/24/2014 18:54:35 HERS Provider: CBPCA
2008 Residential Complianee Forms August 2009
INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS
Refri erant Char e Verification-Standard Measurement Procedure Pa e 2 of 5
Site Address: Enforcement Agency: Permit Number:
21226 E.Davan St Diamond Bar CA 91765 Diamond Bar,City of 14-3669
Standard Charge Measurement Procedure(for use if outdoor air dry-bulb is above 55°F)
Procedures for determining Refrigerant Charge using the Standard Charge Measurement Procedure are available in Reference
Residentia!Appendix RA3.2. As many as 4 systems in the dwe[ling 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 insta!!ed and charged in accordance with the manufacturer's speci/ications be�oi•e starting this procedure.
• The system must meet minimum airflow reguirements as prerequisite for a valyd refrigerant charge test.
• I.f outdoor air dry-bulb is 55°F or below,the installer must use the Alternate Charge Measuremenl Procedure.
S ace Conditionin S stems
System Name or identification/Tag System 1
System Location or Area Served House
Outdoor Unit Serial# 5813m01264
Outdoor Unit Make Lennox
Outdoor Unit Model xc14-042-230-04
Nominal C �� - B �� @
�t s�_ �
, � u�a � � � � a �.
Date of Verificatio 8/9/�014 +� ��
�,� �.� . ,;�.:� �.
,au;sr�-� ;�
Calibratio of� i� nostic �nsfr_ , ,�� -
Date of Re ,�rtgeranl Gauge Ca�lib �� n� �-�2yD1��4 � (must be re-calibrated monthly)
��i�cvn.. ...Y„�,. .... �:i��� .�_ l��il ........�:�-�
T
Date of Therm�C.�p�s��"ibrati ��;�� ��,a� ` '�� 8/1/2��1,4 �'�mus�-��-��c ���'�rated monthlY)
—�=�— -��"�, ..�'" � ��
_�__
Measured Tem eratures °F �� �,,,;�, �`' :�'� ._ ;;' -�=--
_ �, _ , ; i hF� �,'s
System Name or Tdentification/Tag SpSt t;T't,1 �E� L-� � },� '��
Supply(evaporator leaving)air dry-bulb - � ��- �� ��
temperature(Tsu 1 ,db) 54.00
Return(evaporator entering)air dry-bulb
temperature(Treturn,db) 74.00
Return(evaporator entering)air wet-bulb 61.00
temperature(Trctum,wb)
Evaporator saturation temperature
44.00
�Teva orator,sat�
Condensor saturation temperature �
102.00
�Tcondensov saJ
Suction line temperature(Tsuct;on) 63.00
Liquid Line Temperature(T�;q,,;� 96.00
Condenser(entering)air dry-bulb
tem erature T 90.00
P � condenser db�
Registration Number: 3ia-nooz�oein-nnzszss3sn-0000 Registration Date/Time: 09/24/2014 18:54:35 HERS Provider: CBPCA .
2008 Residential Compliance Forms August 2009
�
INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS
Refri erant Char e Verification-Standard Measurement Procedure Pa e 3 of 5
Site Address: Enforcement Agency: Permit Number:
21226 E.Davan St Diamond Bar CA 91765 Diamond Bar,City of 14-3669
Minimum Airtlow Re uirement
Temperature Split Method Calculations for determining Minimum Airflow Requirement for Refrigerant Charge
Verification. The temperature spiit method is specified in Reference Residential Appendix RA3.2.
System Name or ldentification/Tag System 1
Calculate: Actual Temperature Split= 20.00
Tretum>db'Tsupply+db
Target Temperature Split from Table 19.30
RA3.2-3 using Tretum�wb and Treturn�db
Calculate difference: Actual Temperature
Split—Target Temperature Split= 0.70
Passes if difference is between-3°F and Pass
+3°For,up r � � � � � �� e" ;��:�� ��� � �° �. � �� � �� �
-3°F and-1 e� a a
., �.. y,.. �, � a'.� .�.!� � ,� �
Note: Temp �� �`P�, eth�=d ��C� u a 'r���� t ��� s �� � �� li g� , ,� s , � � � � � ne of the ,
� ��
Ey��Z'i'�'i ,���
airflow measttr�rn�ent proce�ures a�`t � ��r�nc esid n�1ta Apper�d' � �3. If actual cooling coil airflow is �
�����r�� ;, � �'ti�n th�G�nl�u tZFe�� �� � -� ���Reguirement in the table below. �
measured, t e u�,�e must be equ „� o �e,„ �„,� ., � �_� �
� „��� � :
Calculated ��� � � `, z�'���t� �u ra ..��� .�, _ - .
�mum-� 'rIlo����R, ����ment ; � _ �lomir�al Coii$ g Capacity(ton�"`�Z� 300 �c�i�/ton)
,i;
_. . .- i�j; M� i.
��� �;
�.�M1`��V�'.� 1q. �i�r h _� � ,'j n:
System Name or ldentification/T yst��'Ci�I `
- � �.0 T _ `�" � �i
����,t �„ w;
Calculated Minimum Airflow
Requirement(CFM) ����'�� � � �
Measured Airflow using RA3.3
procedures(CFM) 1325.00
Passes if ineasured airflow is greater than Pass
or equal to the calculated minimum
airflow 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 System 1
Calculate: Actual Superheat=
Tsuction—Teva orator sat
Target Superheat from Table RA3.2-2
using Treturn�wb and Tcondensen db
Calculate difference:
Actual Su erheat—Tar et Su erheat=
System passes if difference is between
-5°F and+5°F Enter Pass or Fail
RCgISG'Q[lOil NUIriFICY: 314-A0021081A-M2526933A-0000 Registration Date/Time: 09/24/2014 18:54:35 HERSProvider: CBPCA
2008 Residential Compliance Forms August 2009
INS�'ALLATION CERTIFICATE CF-6R-MECH-25-HERS
i Refri erant Char e Verification-Standard Measurement Procedure Pa e 4 of 5
Site Address: Enforcement Agency: Permit Number:
21226 E.Davan St Diamond Bar CA 91765 Diamond Bar,City of 14-3669
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.
I System Name or ldentification/Tag System 1
Calculate: Actual Subcooling=
6.00
Tcondcnscr Sat—Tll Lid
Target Subcooling specified by 7.00
manufacturer
Calculate difference: -1.00
Actual Subcoolin —Tar et Subcoolin =
System passes if difference is between Pass
-3°F and+3°F 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: � � �a �
Tsuction —Tev brator sat°,� � e�sm`� .a�,a�a.� ,.+�. � ��
Enter allowat�le su�,h ai ge m �. � '� � .. +� ''�
manufactur� 'sspecifications or �� ���
. 0�-�5�0 _.
between 4°F and'25°F if manufa
s ecification i�nct`availa6le,= �
System passes 1f CiU 1'Super ea i in �! �
, � �
the allowable su �ea�ratige �g� �.
�� Q
Enter Pa ��-� '
�
�. _ _ .,,� .. w
- �x�� ��-�,-�'
,;r,,� ,�� ��� ,�-
_ �
��k
a, a,a � .
_,:{' � .� ���. ��
RCglSl7'ClllOIl NU»IIJCY: 314-A0021081A-M2526933A-0000 Registration Date/Time: 09/24/2014 18:54:35 HERS Provider: CBPCA .
2008 Residential Compliance Forms August 2009
r INS ALLATION CERTIFICATE CF-6R-MECH-25-HERS
Refri erant Char e Verification-Standard Measurement Procedure Pa e 5 of 5
Site Address: Enforcement Agency: Permit Number:
21226 E.Davan St Diamond Bar CA 91765 Diamond Bar,City of 14-3669
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
a licable verification criteria must be re-measured and/or recalculated.
System Name or ldentification/Tag System 1
System meets all refrigerant charge and pass
airflow re uirements. Enter Pass or Fail
_� ��� �� �� � , � .
��� ��: � ��� ��� _ � � �
�
,,,�+ „ � ,- �.,, �
� ,;;�
y � I
DECLARATIO' S,T�TEM�t+FT �� ���' s= �,�� ,� �t�E w;,H �
• I certify under penalty of pequry ' d���� � � �E�S� t�f Gai�f� � o ��vid�ed on thz��foz�zi�tS�,true and correct.
_�
• I am eligible under Division 3 o pfesszon �qd'e tp.ac e i " fo cohshu�tion o�`an authorized
� ��,x^� �
representative of the person responsible for cons Yuct4on,�i,re§ponsibie person}. � � a�� ,
�� �
• I certify that the installed features,materials,compon ts�ti manufactured devices identified€�u�this cerfifieaY ttt�'installation)
conforms to all applicable codes and regulations,and#he-installation is consistent with the plans'�an�'"d�.sp�eeif caEions�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 corcec[ive 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.
• I reviewed a copy of the Certificate of Compliance(CF-1 R)form approved by the enforcement agency that identifies the specific
requirements for the installation. I certify that the requirements detailed on the CF-I R 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 altematives,and beginning October l,2010,for all low-rise residential buildings.
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
Cypress Heating 8 Air Conditioning
Responsible Person's Name: Responsible Person's Signature:
Gary Alderete Gary Alderete
CSLB License: Date Signed: Position With Company(Title):
302865 9/24/2014 Sales Manager
Is this installation monitored by a Third Party Quality Control Name of TPQCP(if applicable):
Program(TPQCP)? ❑Yes ❑✓No
RCg1SIYClIIOII NUIribCY: 314-A0021081A-M2526933A-0000 Registration Date/Time: 09/24/2014 18:54:35 HERS Provider: CBPCA
2008 Residential Compliance Forms August 2009