HomeMy WebLinkAbout15-0093CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
21810 Copley Drive, Diamond Bar, CA 91765 PRESS
(909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 FIRMLY
BUILDING PERMIT APPLICATION
JOB SITE ADDRESS 2a
920q J& CAGr=K FV
APIN A A,LOT , ��T/R�ACT
OWNER LbRR Mi wg_— 7161
ADDRESS
CITY Q DNDf ZIPTEL.
APPLICANT TEL. 711
CONTRACTOR M O
ADDRESS
CITY i% ZIP TEL.
ARCH/ENG/DESIGNER !
ADDRESS
CITY ZIP TEL.
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the reason(s)
indicated below by the checkmark(s), I have placed next to the applicable item(s) [Section 7031.5, Business and
Professions Code: Any city or county that requires a permit to construct, alter, Improve, demolish, or repair, any
structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she
Is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9) Commencing with Section
70M of Division 3 of the Business and Professions Code] or that he or she is exempt from licensure and the basis for
the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty
of not more than five hundred dollars ($500).
U I, as owner of the property, or my employees with wages as their sole compensation, will do U all of or (J portions
of the work, and the structure is not intended or offered for sale (Section 7044, Business and Professions Code: The
Contractors' State License Law does not apply to an owner of property who, through employees' or personal effort, builds
or improves the property, provided that the improvements are not intended or offered for sale. If however, the building or
improvement is sold within one year of completion, the Owner -Builder will have the burden of proving that it was not built
or improved for the purpose of sale.).
U 1, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who
builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State
License Law.).
U I am exempt from licensure under the Contractor's State License law for the following reason(s):
By my signature below I acknowledge that, except for my personal residence in which I must have resided for at least one
year prior to completion of the improvements covered by this permit,[ cannot legally sell a structure that I have built as an
owner -builder if it has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable
law, Section 7044 of the Business and Professions Code is available upon request when this application is submitted or at
the following Web site: http/www.leginfo.ca.gov/calaw,html.
DATE: SIGN:
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000)
of Division 3 of the Businesss andProfessionsCode, and my license is in full force and effect. c
LICENSE CLASS: �jL�J r1 LIC. NO.: J
DATE: CONTRACTOR:
WORKER'S COMPEN ATION DECLARATION
I HEREBYAFFIRM UNDER PENALTYOF PERJURYONE OFTHE FOLLOWING DECLARATIONS:
I have and will maintain a Certificate of Consent to Self -Insure for Worker's Compensation, as provided by
Section 3700 of the Labor Code, far the performance of the work for which this permit is issued.
'11L I have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for
the performance of the work for which this permit is issued. My Worker's Compensation Insurance Carrier and
Policy Number are:
CARRIER (� V
POLICY NUMBER ���
(THIS SECTION NEED NOT BE CO PLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($100) OR LESS).
I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to
become subject to the Worker's Compensation Laws of California. And agree that if I should become subject to the Worker's
Compen tion p visi of Section 3700 of the La�shaorthWthomply with those provisions.
DATE: APPLICANT:WARNIN : Failure to secure Worker's Compens, and shall subject an employer to criminal
penalties and civil Ones up to one hundred tho,, in addition to the cost of the compensation,
damages as provided for in section 3708 of the labor code, interest, and attorney's fees.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a Construction Lending Agency for the performance of the work for
which this permit is issued (Sec. 3097, Civ. C.).
LENDER'S NAME:
LENDER'S ADDRESS:
I certify that I have read this application and state that the above information is correct. I agree to comply with all city and
county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to
enter upon the above-mentioned property for inspection purposes.
PERMITTEE NAME (PRINT)
I
SIGNATURE OF PER TT DATE
APPLICATION DATE: / ��
ISSUE DATE: �J �W
TYPE CONST.
J P/C# OQ ?
PERMIT# I- 004J)
OCC GROUP:
ZONING SETBACKS
FRONT
REAR
SIDE/SIDE STREET
SIDE
RW ❑
❑
RW ❑
❑
PROPOSED USE
# DWEL. UNITS If STORIES # BEDROOMS
DESCRIPTION SQ. FT
FACTOR PSF ADJ. AREAIVALUATION
SFR/ADD/REM
Garage/Carport
Lu
Patio/Deck
W
Pool/Spa
ZRe
-Roof
O
co
Commercial
m
Valuation:
Adj. Area:
QUANTITY
DESCRIPTION FEE
U
U
w
w
c�
_z
i
¢
AA
V
U
Q
U
CONSTRUCTION:
PLAN REVIEW:
ELECTRIC:
PLUMBING:
MECHANICAL:
E�
INSPECTION FEE:
ISSUANCE:
SMIP:
rr�
ENERGY P/C:
ENERGY PERMIT:
RETENTION FEE:
PRE -ALT FEE:
BSAF:
TOTAL FEES
COMMENTS:
joal A fl
V 7
RECEIPT # 41919___ PAID
BY: VALIDATION:J0 77,
WHITE — Department Copy, YELLOW — Finance Copy, PINK — Assessor Copy, GOLDENROD — File Copy, GREEN — Applicant's Copy
UPPLUMBING
ELEGTRfCALX-
LIFER GROUNDI ,,4,%
SEWER LATERAL
MAIN WATER LINE
SEWER CLEANOUT
ROOF SHEATHING
FLOOR SHEATHING
„SHEAR WALLS16TE RIOR
>E'All WALLS, INTERIOR
7FRAMIINGNEhTING
ROl1GH.,MECHANLc'A6'
ROUGH ELECTRICAL W(
.HOUGH PLUMBING
INSULATION WALL
INSULATION CEILING
DRYWALL
LATH (PRE)
LATH EXTERIOR
LATH INTERIOR
GAS TEST
SCRATCH COAT
ELECTRIC METER RELEASE
GAS METER RELEASE
SPECIAL INSPECTION
FINAL BUILDING -
FINAL Mi(OANICAL.
,F]INALECt(fRICAL.
FINAL PLUMBING .... .....
f"C'. of OCCUPANCY ' ' ' '
,CEiff?ofb0RUPkhCY' ,
COMMENTS: -
CITY OF DIAMOND BAR
INSPECT110N RECORD
V
TRACT AND LEDGER
SWITCH GEAR
COMMERCIAL HOOD
T -BAR
INTERCEPTER
HOT MOP/SHOWERPAN
,[SEPTIC/CESSPOOL
HERS REPORT RECEIVED
DEMOLITION
ROOF DRAINS
ROUGH CONDUIT
POOIJSPA
ROUGH PLUMBING
ROUGH ELECTRICAL
,ROUGH MECHANICAL
GAS TEST
PRE GUNITE
POOL PRE DECK BONDING
P -TRAP
,FENCE / GATE/ ALARM
FINAL POOL -
WALLS:
WALL FOOTING/STEEL
WALL STEEL 1sT( ) 2t4L( LIFT
WALL BOND BEAM
WALL DRAIN/ SEAL
WALL FINAL
RO. FRAMING PLANNING APPROVAL
,ROUGH FIRE APPROVAL
,FINAL FIRE DEPARTMENT
FINAL PLANNING
FINAL ENGINEERING/ PW
FINAL COMMUNITY SERVICES
[FINAL HEALTH DEPT,
FINAL INDUSTRIAL WASTE
STATE OF CALIFORNIA
ALTERATIONS - HVAC
CEC-CFIR-ALT-04-E (Revised 06/14) _ CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE _ CFIR-ALT-04-E
Alterations - HVAC CZ 2, and 8-15 (formerly CF -IR -ALT -HVAC) (Page 1 of 1)
Site Address:
7-119 look CIO
Enforcement Agency:
Date Prepared:
Permit#:
Equipment Type
Equipment Efficiency
New Ducting, Plenums, Lineset:
Conditioned
Thermostat
Required R -value
Floor Area (sq ft)
❑ Packaged System
❑ Evaporator Coil
AFUE
COP
❑ R-6 (CZ 2, 8-13) Ducting
Served by system
❑ Setback
Split System
❑ Condensing Unit
❑ R-81 (CZ 11, 14, 15) Ducting
sqft
(if not already
❑ Mini Split
Furnace
❑ Compressor
13 Lineset
SEER
HSPFpresent,
❑ R 6 (all CZ's) Plenums
must
be installed)
EER
❑ R-5 or R7.5) Lineset`
❑ TXV
HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options below. At permit application this
form is allowed to be filled out by hand. For final inspection all forms are to be registered (no hand filled forms allowed) and a copy left on site.
1. HVAC Changeout/Repair
Required Compliance Documents to be left on site for Final:
All Equipment,
CF111-ALT-02-E
Condenser Unit, Evaporator Coil,
CF2R: MECH-01, MECH-20-HERS, MECH-(23 or 24)2 -HERS, MECH-25-HERS2
Compressor, TXV, Lineset,
CF3R: MECH-20-HERS, MECH-(23 or 24)-HERS2, MECH-25-HERS2
Air Handler/Furnace2 (Can include new ducting)
Installer Requirement: Duct leakage (L15%, or < 10% to outside, or seal all accessible leaks), Air Flow 2 300 CFM/ton, Refrigerant Charge.
Exempted from duct leakage testing if:
❑ 1. Duct system registered with HERS provider as previously sealed, or ❑ 2. There is less than 40 linear feet of duct in unconditioned space, or
❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos (list manufacture date of building ........
❑ 2. New HVAC System
Required Compliance Documents to be left on site for Final:
All new equipment and All New Ducts'
CF1R-ALT-02-E
including Mini Split
CF2R: MECH-01, MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24)-HERS2, MECH-25-HERS2
CF3R: MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24)-HERS2, MECH-25-HERS2
Mini Splits require CF111-ALT-02-E, CF2R-MECH-01, and (CF2R-CF3R) MECH-25-HERS
Installer Requirement: Duct leakage < 6%, Fan Efficacy (.58W/CFM), Air Flow >_ 350 CFM/ton (or alternative), Refrigerant Charge
❑ 3. All New Duds with Replacement Required Compliance Documents to be left on site for Final:
All New Ducts' and one or more of the following CF111-ALT-02-E
replaced: Condenser Unit, Evaporator Coil, CF2R: MECH-01, MECH-20-HERS, MECH-(23 or 24) -HERS, MECH-25-HERS
Compressor, TXV, Lineset, Furnace' CF3R: MECH-20-HERS, MECH-(23 or 24) -HERS, MECH-25-HERS
Installer Requirement: Duct leakage < 6%, Air Flow z 350 CFM/ton (or alternative), Refrigerant Charge
Exempted from duct leakage testing if: ❑ 1. Existing duct systems are constructed, insulated or sealed with asbestos
❑ 4. New Ducting over 40 feet Required Compliance Documents to be left on site for Final:
New ducting but less than All New Duds' I CF111-ALT-02-E, CF2R: MECH-20-HERS, CF3R: MECH-20-HERS
Installer Required to: Duct leakage (IS.15% or, < 10% to outside or, or seal all accessible leaks)
❑ EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos.
' All new ducting R-8 required when more than 40 ft installed and R-6 when less than 40 ft installed. This includes in walls, between floors etc.
2 Heating only systems and Air Handler/Furnace changes do not require Air Flow MECH-(23 or 24), or Refrigerant Charge verification MECH-25
' All New Ducts is when at least 75 percent of the duct system is new duct material, and up to 25 percent may consist of reused parts from the
dwelling unit's existing duct system (e.g., registers, grilles, boots, air handler, coil, plenums, duct material)
` R-5 (1" thick insulation) for linesets 1" and less. R-7.5 (1.5" thick insulation) for linesets over 1 inch. Most mfg will require Suction line Diameter
with insulation as the following 1.5-2T-2%", 2.5-3T-2%", 3.5 to 4T-2%", 5T-4'/."
Contractor (Documentation Author's /Responsible Designer's Declaration Statement)
I certify the following under penalty of perjury, under the laws of the State of California:
1. The information provided on this Certificate of Compliance is true and correct.
2. 1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the information on this document.
3. That the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the
requirements of Title 24, Parts 1 and 6 of the California Code of Regulations (CCR).
4. That the energy features and performance specifications, materials, components, and manufactured devices for the building design or
system design identified on this Certificate of Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the CCR.
5. The building design features or system design features identified on this Certificate of Compliance are consistent with the information
provided on other applicable compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement
agency for approval with this building permit application.
Responsible Designer Name:
o -a klm VAM
Responsible Designer Signature:
ova kw VA
Date Signed:
t - t3 -tion S'
License:
�)M65'
Company � M
vt
Address:Ciry/State/Zip:
Woo y[
Phone:
For dssrszdnce or questions regaramg the tnergy btanaaras, contact the Energy Hotline at: 1-800-772-3300
3,6
CERTIFICATE OF COMPLIANCE
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC)
Project Name:
SIGLER, LORRAINE I Date Prepared:
CF1R-ALT-02-E
(Page 1 of 3 )
2015-02-20
A. General Information
CFIR-ALT 02 is applicable to multiple space conditioning systems contained within a single dwelling unit. When multiple dwelling units must be
documented, use one CHR -ALT -02 document for each dwelling unit.
01
Project Name
SIGLER, LORRAINE
02
Date Prepared
2015-02-20
03
Project Location
22839 DRY CREEK RD
04
Building Type
Single family
05
CA City
Diamond Bar
06
Dwelling Unit Name
SIGLER, LORRAINE
07
Zip Code
91765
08
Dwelling Unit Conditioned
1644
Installing new SC
Installing
Installing
Installing
Floor Area (ft2)
Identification or
Location or Area
by this SC
ducted
containing
Number of space conditioning
more than 40
09
Climate Zone
9
10
(SC) systems in this dwelling
1
system?
component?
components?
feet of ducts?
unit.
SC system?
B. Space Conditioning (SQSystem rmation
01
02
n. 03
OS:
":�06 ��
07 �`;
rOS
09
10
Is the SC'-
Install`
SC System
SC System
CFA served
system a
refrigerant
Installing new SC
Installing
Installing
Installing
Identification or
Location or Area
by this SC
ducted
containing
system
more than 40
entirely new
entirely new
Name
Served
System (ft2)
system?
component?
components?
feet of ducts?
duct system?
SC system?
Alteration Type
Altered space
System 1 I
Location 1
1644
Yes
No
Yes
No
No
No
conditioning system
C. Extension of Existing Duct System, Greater Than 40 Feet (Section 150.2(b)1Diib)
This section does not apply to this project.
Registration Number: 215-A0048908A-000000000-0000
Registration Date/Time
2015-02-20 10:30:16
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-02-20 10:30:07
Schema Version: 0.551SDD
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -1R -ALT -HVAC) (Page 2 of 3 )
D. Altered Space Conditioning System (Sections 150.2(b)lE and F)
01
02
03
04
05
06
07
08
09
10
11
12
Heating
Cooling
System
Heating
Altered
Heating
Minimum
Altered
Cooling
Minimum
Required
New or
Identification
System
Heating
Efficiency
Efficiency
Cooling
Cooling
Efficiency
Efficiency
Thermostat
Replaced
New Duct
or Name
Type
Components
Type
Value
System Type
Components
Type
Value
Type
Duct Length
R -Value
Central gas
Gas furnace
Central large
No cooling
This field or
This field or
This field or
This field or
System 1
furnace
AHU
AFUE
0.78
packaged AC
component
section is not
section is not
Setback
section is not
section is not
altered
applicable
applicable
applicable
applicable
Required Documentation:
CF2R-MCH-01-E - Space Conditioning Systems Ducts and Fans
-Duct insulation requirement for new plenums: RE.
CF2R-MCH-20-H & CF3R-MCH-20-H — Duct Leakage testing required when heating or cooling components are installed in ducted systems, or when more than 40 ft of duct length is replaced.
-Leakage rate compliance: <_ 15%, or 5 10% leakage to outside, or seal all accessible leaks.
CF2R-MCH-25-H & CF3R-MCH-25-H Refrigerant Charge Verification required when refrigerant containing components are installed or altered (applicable in CZ 2, 8-15).
CF2RCF3R-MCH-23 & CF3R-MCH-23 Air Flow >_ 300 CFM/ton required when MCH 25 is_required.
Exceptions:a,
big �
-Duct systems registered with HERS provider as previously sealed are exempt from MCH -20 Duct Leak'a ea sting requirements. k
-Heating-only systems and Air Handler/Furnace changes do not require verificationoof Air Flow MCH 23; or Refrigerant'Charge MECH 25. y
-Existing duct systems constructed, insulated or sealed with asbestos are exempt from MCH720 Duct Leakage Testing requirements `
E. Entirely New or Complete Replacement Duct System, with or without Equipment Changeout (Sections 150.2(b)lDiia and 150.2(b)lE, F)
This section does not apply to this project.
F. Entirely New or Complete Replacement Space Conditioning System (Section 150.2(b)lC)
This section does not apply to this project.
Registration Number: 215-A0048908A-000000000-0000 Registration Date/Time: 2015-02-20 10:30:16 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-02-20 10:30:07
Schema Version: 0.551SDD
CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E
Alterations to Space Conditioning Systems (formerly CF -1R -ALT HVAC) (Page 3 of 3 )
Documentation Author's Declaration Statement
1. 1 certify that this Certificate of Compliance documentation is accurate and complete.
Documentation Author Name:
Documentation Author Signature:
Kim, Howard
7���ti�GIYl/
Company:
Signature Date:
CHOICE AIR
2015-02-20 10:30:16
Address:
CEA/ HERS Certification Identification (if applicable):
3633 WOODPECKER ST
City/State/Zip:
Phone:
BREA CA 92823
(714) 388-7986
Responsible Person's Declaration statement
I certify the following under penalty of perjury, under the laws of the State of California:
i. The information provided on this Certificate of Compliance is true and correct.
2. I am eligible under Division 3 of the Business and;Professions Code to accept, resppnsibility,for, the building design or system. identified on this Certificate of Compliance (responsible designer).
3. That the energy features and performance specifications, materials,,com; a
ponentsnd manufactured devices for the building design or system design identified on this Certificate of Compliance conform to the
requirements of Title 24, Part 1 and Part.6 of the California Code of Regulations. 0'
4. The building design features or system design features` identified onthis Certificate of Compliance are consistent with 6e.informati6n+provided on other applicable compliance documents, worksheets,
calculations, plans and specifications submitted to,the enforcement agency for approval with this bwldmg permit application.
5. 1 will ensure that a registered copy of this, Certificate of,6hipliance shall be made availablemith the'huildi g permits) issued for the building and made available to the enforcement agency for all applicable
inspections. I understand that a registered copy of this Certificate of Compliance is required to be included with the documentation the builder provides to the building owner at occupancy.
Responsible Designer Name:
Responsible Designer Signature: 11 ��� JJ
e&
Kim, Howard
Y&*Pr ll
Company:
Date Signed:
CHOICE AIR
2015-02-20 10:30:16
Address:
License:
3633 WOODPECKER ST
855665
City/State/Zip:
Phone:
BREA CA 92823
(714) 388-7986
Digitally signed by CaICERTS. This digital signature is provided in order to secure the content of this registered document, and in noway implies Registration Provider responsibility for the accuracy of the information.
Registration Number: 215-A0048908A-000000000-0000 Registration Date/Time: 2015-02-20 10:30:16 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-03-31 Report Generated: 2015-02-20' 10:30:07
Schema Version: 0.551SDD
CERTIFICATE OF INSTALLATION
CF2R-MCH-01-E
Space Conditioning Systems, Ducts, and Fans
(Page 1 of 7 )
Project Name: SIGLER, LORRAINE
Enforcement Agency: City of Diamond Bar
Permit Number:
15-0093
Dwelling Address: 22839 DRY CREEK RD
City: Diamond Bar
Zip Code:
91765
A. General Information
01
Dwelling Unit Name
SIGLER, LORRAINE
02
Climate Zone
9
07
Dwelling Unit Conditioned Floor Area
09
10
Number of space conditioning (SC)
03
(ft2)
1644
04
systems being altered in this dwelling
1
Are a-11 of the
unit.
05
Certificate of Compliance Type
Prescriptive alterations (CF1R-ALT)
06
Method used to calculate HVAC loads
ACCA_ManuaU
07
Calculated dwelling unit Sensible
0
08
Calculated Dwelling Unit Heating Load
110000
Cooling Load (Btuh)
components
(Btuh)
MCH -01b Prescriptive Alterations =Space Conditioning Systems Ducts and Fans
B. Space Conditioning (SC) System Information
01
02
03
04
05
06
07
08
09
10
Are a-11 of the
system's
components
and ducts
CFA served
Is the SC
Installing a
Installing
new or
SC System
SC System
by this SC
system a
refrigerant
Installing new SC
Installing more
entirely
replaced?
Identification or
Location or Area
System
ducted
containing
system
than 40 feet of
new duct
(entirely new
Name
Served
(ft2)
system?
component?
components?
ducts?
system?
system)
Alteration Type
J
Altered space
System 1
Location 1
1644
Yes
No
Yes
No
No
No
conditioning
system
Registration Number: 215-A0048908A-M0100002A-0000
Registration Date/Time: 2015-02-20 10:42:13
HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-05-13 Report Generated: 2015-02-20 10:39:45
Schema Version: 0.551SDD
CERTIFICATE OF INSTALLATION CF2R-MCH-01-E
Space Conditioning Systems, Ducts, and Fans (Page 2 of 7 )
C. Space Conditioning (SC) System Alterations Compliance Information
O1
02
03
04
05
06
07
08
09
10
11
12
Heating Unit serial
number
Rated Heating Capacity,
Output (BTUH)
System 1
AFUE
Heating
KENMORE
F81VIXL1102120A
A143017113
Cooling
New or
New
System
Altered
Heating
Minimum
Altered
Cooling
Minimum
Required
Replaced
Duct
Identification
Heating
Heating
Efficiency
Efficiency
Cooling
Cooling
Efficiency
Efficiency
Thermostat
Duct
R-
od Name
System Type
Component
Type
Value
System Type
Component
Type
Value
Type
Length
Value
This
This field
This field
field or
Central gas
Gas furnace
Central large
No cooling
or section
or section
Nno
section
System 1
furnace
AHU
AFUE
0.78
packaged AC
component
is not
is not
Setback
d u cts
du
is not
altered
applicabl
applicable
replaced
applica
e
ble
D. Installed Heating Equipment information`mss'
01
0203ti
=
04H`'"`
05
06
07
System Identification or
Name
Heating Efficiency Type
.Heating Efficiency
"!Vitae - x-
Heatmg;Umt
-Manufactiiire� �'
J Heating Unit
Modei Number
Heating Unit serial
number
Rated Heating Capacity,
Output (BTUH)
System 1
AFUE
0.78
KENMORE
F81VIXL1102120A
A143017113
110000
Notes:
E. Installed Cooling Equipment information:
This section does not apply to this project.
F. Extension of Existing Duct System, Greater Than 40 Feet
This section does not apply to this project.
Registration Number: 215-A0048908A-M0100002A-0000 Registration Date/Time: 2015-02-20 10:42:13 HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-05-13 Report Generated: 2015-02-20 10:39:45
Schema Version: 0.551SDD
CERTIFICATE OF INSTALLATION CF2R-MCH-01-E
Space Conditioning Systems, Ducts, and Fans (Page 3 of 7 )
G. Installed Duct System information
This section does not apply to this project.
H. Installed Air Filter Device Information
This section does not apply to this project.
I. Air Filter Device Requirements
This section does not apply to this project.
�s 7 ° F
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Registration Number: 215-A0048908A-M0100002A-0000 Registration Date/Time: 2015-02-20 10:42:13
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-05-13
Schema Version: 0.551SDD
HERS Provider: CaICERTS
Report Generated: 2015-02-20 10:39:45
CERTIFICATE OF INSTALLATION CF2R-MCH-01-E
Space Conditioning Systems, Duds, and Fans (Page 4 of 7 )
J. HERS Verification Requirements
01
02
03
04
05
06
07
08
09
10
MCH2O
MCH21
MCH22
MCH23
MCH25
MCH28
Exemption
from
Minimum
Exemption
R -Value for
AHU Fan
AHU
SC System
SC System
From Duct
Duct
Ducts In
Ducts Located
Efficacy
Airflow
Identification or
Location or Area
Leakage
Leakage
Conditioned
In Cond Space
(W per
Rate (cfm
Refrigerant
Return Duct Design
Name
Served
Requirements
Test
Space
Verification
cfm)
per ton)
Charge
Table 150.0-C or D
Existing duct
system is
Not
System 1
Location 1
insulated or
No
No
No
No
No
No
"sealed with
- y
applicablej, i
asbestos
_
40,
Registration Number: 215-A0048908A-M0100002A-0000 Registration Date/Time: 2015-02-20 10:42:13 HERS Provider: CalCERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-05-13 Report Generated: 2015-02-20 10:39:45
Schema Version: 0.551SDD
CERTIFICATE OF INSTALLATION CF2R-MCH-01-E
Space Conditioning Systems, Ducts, and Fans (Page 5 of 7 )
K. Space Conditioning Systems, Ducts and Fans Mandatory Requirements and Additional Measures
Note: Additional mandatory requirements from Section 150.0 that are not listed here may be applicable to some systems. These requirements may be applicable to only newly installed equipment or portions of the
system that are altered. Existing equipment may be exempt from these requirements.
Heating Equipment
Equipment Efficiency: All heating equipment must meet the minimum efficiency requirements of Section 110.1 and Section 110.2(a) and the Appliance Efficiency
01
Regulations.
Controls: All unitary heating systems, including heat pumps, must be controlled by a setback thermostat. These thermostats must be capable of allowing the occupant
02
to program the temperature set points for at least four different periods in 24 hours. See Sections 150.0(i), 110.2(b).
03
Sizing: Heating load calculations must be done on portions of the building served by new heating systems to prevent inadvertent undersizing or oversizing. See sections
150.0(h)1 and 2).
04
Furnace Temperature Rise: Central forced -air heating furnace installations must be configured to operate at or below the furnace manufacturer's maximum
inlet -to -outlet temperature rise specificafibn. See Section 1500(h)4
05
Standby Losses and Pilot Lights:Fan-type central furnaces may not have a`continuously;burning pilot light Section 110.5 and Section 110.2(d).
s Yom �
Cooling Equipment
06
Equipment Efficiency: All cooling equipment must meet the minimum efficiency requirements of Section 110.1 and Section 110.2(a) and the Appliance Efficiency
Regulations.
07
Refrigerant Line Insulation: All refrigerant line insulation in split system air conditioners and heat pumps must meet the R -value and protection requirements of Section
150.0(j)2 and 3, and Section 150.0(m)9.
08
Condensing Unit Location: Condensing units shall not be placed within five (5) feet of a dryer vent outlet. See Section 150.0(h)3A.
09
Sizing: Cooling load calculations must be done on portions of the building served by new cooling systems to prevent inadvertent undersizing or oversizing. See Section
150.0(h)1 and 2.
Air Distribution System Ducts, Plenums and Fans
10
Insulation: In all cases, unless ducts are enclosed entirely in directly conditioned space, the minimum duct insulation value is R-6. Note that higher values may be
required by the prescriptive or performance requirements. See Section 150.0(m)1.
Registration Number: 215-A0048908A-M0100002A-0000 Registration Date/Time: 2015-02-20 10:42:13 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-05-13 Report Generated: 2015-02-20 10:39:45
Schema Version: 0.551SDD
CERTIFICATE OF INSTALLATION CF2R-MCH-01-E
Space Conditioning Systems, Ducts, and Fans (Page 6 of 7 )
K. Space Conditioning Systems, Ducts and Fans Mandatory Requirements and Additional Measures
Note: Additional mandatory requirements from Section 150.0 that are not listed here may be applicable to some systems. These requirements may be applicable to only newly installed equipment or portions of the
system that are altered. Existing equipment may be exempt from these requirements.
Connections and Closures: All installed air -distribution system ducts and plenums must be, sealed and insulated to meet the requirements of CMC Sections 601.0,
it
602.0, 603.0, 604.0, 605.0 and ANSI/SMACNA-006-2006: Supply -air and return -air ducts and plenums must be insulated to a minimum installed level of R-6.0 or
enclosed entirely in directly conditioned space as confirmed through field verification and diagnostic testing in accordance with the requirements of Reference
Residential Appendix RA3.1.4.3.8.
Heat Pump Thermostat
12
A thermostat shall be installed that meets the requirements of Section 110.2(b) and Section 110.2(c).
13
The thermostat shall be installed in accordance with the manufacturers published installation specifications
14
First stage of heating shall be assigned to heat pump heating.
15
Second stage back up heating shall beset to come on'orily when the indoor set4emperature cannot be met
The responsible person signature on, his compliance document affirms that"' II`ipplicable requirementsin this table have'been met.
Registration Number: 215-A0048908A-M0100002A-0000 Registration Date/Time: 2015-02-20 10:42:13 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-05-13 Report Generated: 2015-02-20 10:39:45
Schema Version: 0.551SDD
CERTIFICATE OF INSTALLATION CF2R-MCH-01-E
Space Conditioning Systems, Ducts, and Fans (Page 7 of 7 )
Documentation Author's Declaration Statement
1. 1 certify that this Certificate of Installation documentation is accurate and complete.
Documentation Author Name:
Documentation Author Signature:
JJ etw
Kim, Howard
Y&Oza
Company:
Signature Date:
CHOICE AIR
2015-02-20 10:42:13
Address:
CEA/ HERS Certification Identification (if applicable):
3633 WOODPECKER ST
City/State/Zip:
Phone:
BREA CA 92823
(714) 388-7986
Responsible Person's Declaration statement
I certify the following under penalty of perjury, under the laws of the State of California:
1. The information provided on this Certificate of Installation is true and correct.
2. I am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction, or installation of features, materials,
components, or manufactured devices for the scope of work ide"int ified on'this Certificate "of In stallation; and attestto the,declarations in this statement (responsible builder/installer), otherwise I am an
authorized representative of the responsible builder/installer.
3. The constructed or installed features materials components or manufactured devices�(ihe°installation) identified on,this Certificate of Installation conforms to all applicable codes and regulations, and the
installation conforms to the requirements given on theiplans and specifications approved by the enforcement agency:`= '
4. I reviewed a copy of the Certificate of Ccmpliance approved by�he enforcement agency that identifies thespecific requirements for the scope of constructign or installation identified on this Certificate of
Installation, and I have ensured that the requirements that apply to the construction" or installation have been met.
5. 1 will ensure that a registered copy of this Certificate of Installation shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all
applicable inspections. I understand that a registered copy of this Certificate of Installation is required to be included with the documentation the builder provides to the building owner at occupancy.
Responsible Builder/Installer Name:
Responsible Builder/Installer Signature:
Kim, Howardk//�UYf/
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
Position With Company (Title):
CHOICE AIR
OWNER
Address:
CSLB License:
3633 WOODPECKER ST
855665
City/State/Zip:
Phone:
Date Signed:
BREA CA 92823
1(714) 388-7986
2015-02-20 10:42:13
Digitally signed by CaICERTS. This digital signature is provided in order to secure the content of this registered document and in noway implies Registration Provider responsibility for the accuracy of the information.
Registration Number: 215-A0048908A-M0100002A-0000 Registration Date/Time: 2015-02-20 10:42:13 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2014-05-13 Report Generated: 2015-02-20 10:39:45
Schema Version: 0.551SDD