HomeMy WebLinkAbout10-1069 -- -- _,
CITY OF DIAMOND BAR ✓ M
- —��' DEPARTMENT OF COMMUNITY&D�����, ��� ���� �����
�' � 21825 Copley Drive,Diamond Bar,CA 91
(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027�������
���'�� BUILDING PERMTT APPLiCATION
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� OWNER-BUILDER DECLARATION SFR/ADD/REM
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0 I HEREBY AFFIRM UNDER PENALTV OF PERIURV THAT I AM EXEIAPT FROM THE CANTR�CTORS LI� G2f0g0/CBfpOf�
W CENSEUWFORTHEFOLLOWINOREASON(SEC.7031.6BUSINESSANDPROFESSIONSCODE:ANYGTYOR (n
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Z NRE,PRIOR TO ITS ISSUANCE�50 REQUINES THE APPUCANT FOR SULH PERMIT TO FILE A SIONED
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� CENSE LAW�CHMTER D(COMMENCINO W ITH SECTION�000)OF DIVISION 3 Of TME BUSINE55 AND GRO- � POOUSPO
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' � TION.NIV VIOLATION OF SECTION 7031.5 BV ANV MPUCAM FOR A PEWAIT SU&lECTS iHE APPUCANT TO Z fte-Root
� A CML 7ENALN OF NO7 MORE iHAN FIVE HUNDRED DOLIARS(isoo).):
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Z VALL DO THE WOP1C,AND THE STFUCTURE IS NOT INTENOED OR OfFERED FOR SALE(SEC.70at,BUSI- ....I
N NE55 AND 7ROFESSIONS CADE:111E CONTRACTORS LICENSE L�W DOES NDT APPLV TO AN OWNER OF ?
PROPERTV NM1iO BUIIDS OR IMPROVES THEREON,AND WHO DOES SUGH WORK HIMSELF OR HERSELF OR m
[L MROUGHNISORHEROWNEMPLOVEES,PROVIDEDTHATSUCNIMPROVEMFMSARENOTIFITENDEDOR
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Z TION,THE OWNER-BUILDER WILL HAVE TNE BURDEN OF PROVINO THAT HE�SHE DID NOT BUIID OR
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w ❑I,AS OWNER OF THE PROVEHTV.AM EXCLUSIVELV CONTRACTINO WITH LICENSED CONTMCTORS
[[ TO CONSTRUCT THE PROJECT(SEC.701�,BUSINESS AND PROFESSiONS CODE:TNE CONTRACTORS ll- V81U8t1Of1 ADJ.AREA
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� O I AM EXEMPT UNDER SEC. 8.8 P.C.FOR THIS REASON �
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LL" DATE OwNER U
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� UCENSED CONTfiACTORS DECLARATION �
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I HEHEB�AFFIRAI UNOER PENALTY OF PERJURY TMAT I AM LICENSED UNDER PROVISIONS OF CHAPTER V.
d 0(COMAIENCINO WITM SECTION 7000)OF DIVISION 3 OF 7HE BUSINE55 AND GROFESSIONS CADE,AND Z
X MY IICENSE IS IN FUL.L FOACE AND EFFECT. m
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� LICENSE C SS � LIC.NO. J �
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� WORKERS'COMPENSATION DECLARATION �
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� 1 HEREBY AFFiRM UNDER VENALT'OF VERJUPV OHE OF THE iOLLOWING DECLARAT�ONS:
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� _IHAVEANDWILLMAINT�INACERTIFICATEOFCONSEIJTTOSELF-INSUREFORWORKEflS' $
Q COMPENSATION,AS PROVIDED BV SECTION 370o OF THE LABOR CODE,FOR THE PERFORMANCE W
ORK FOR WHIp1 THIS PERMIT IS ISSUED. �
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w WILL AIAINTAIN WORKERS'COMPENSATION INSURPNCE.AS REOUIRED BV SECTIDN
Q 37a0 OF THE 1.A80R CA�E,PoF THE PEFFOFMANCE OF THE WORK FOR WNICH 7HI5 PENMIT IS
ISSUED.MY RNER�S'CAM.qPEN�SAT1ION INSURANCE CARRIER AND POLICY NUMBER ARE: CONSTRUCTION
jCAflRIER��,�JJ��'� ��- - PLAN REVIEW
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Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHIp1 THIS PERAl1T IS ISSUED,I
� SHALL NOT EMPLOV ANV PERSON IN ANV MANNEi1 SO AS TO BECOME SUBJECT TO THE
Vj WORKERS'COMPENSA710N LAWS OF CALIFORNIA.AND AGREE THAT IF I SHOUL�BECOME 1NSPECTION FEE ^ l
S SU&IECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 37000F THE UBOR �S ANCE �'D v
COOE.�SHALL FOHTHWITH COMPIY WITH TH0.5E PROVISIONS.
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p DATE: APPLICANT: , -
w ENERGY P/C
� WARNINO:FAILURE TO SECURE WORKERS'COMPENSATION COVERAOE IS UNLAWFUL,AND SHALI BE
LL SUBJECT Ak EMPLOYEH TO CRtMINAL PENALTIES AND CMl FINES UP TOONE MUNORED THOUSANO ENERGY PERMI
OOLLARS(f 100.000).IN�ODITION TO THE COST OF CAMPENSATION,DMIAOES AS PROVIDED FOR IN
J SECTION 3708 OF THE LABOR CODE.INTEREST,ANO ATTOfUlEV5 FEES. ENTION FEE' - �
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w CONSTRUC710N LENDING AGENCY PRE•ALT FEE:
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� 1 MEREBV AFFIRM UNDER PENALTV OF PEi7JURV THAT THERE IS A CqNSTRUCTION LENDINO AOENCY
FOR THE PERFORMANCE OF THE WORK FOR N7iICN THIS PERAIIT IS ISSUED(SEC.30Y7.C��.C.). �
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� LENDEFi'S NAME
F- IENDER"S ADDRESS 1�y ��\
� TOTAL FEES '�' d -�"
� I CERTIFV THAT I HAVE FEAD THIS APPUCATION AND STATE THAT THE ABOVE INFORMATION IS CARRECT,
w I AGREE TO COMPLY WITH ALL CITV AN�COUNTV OFOINANCES AND STATE LAWS RELATINO TO BUILOINQ
� CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE
ZA60VE�MENTIONED PROPERTV FOR INSPECTION PURPOS s. COMMENTS �
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� WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOIDENROD—File Copy,(iREEN—Applicant's Copy
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FTGS/FORMS/STEEL FHA REQMTS
ELECTRIC GROUND UNDER FLOOR DUCT -.i.•"'•��
GROUND PLUMBING UNDER FLOOR CONDUIT � ' •
SLAB GRADE FIREPLACE FOUNDATION '
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MID H'L BOND BEAM �
ROOF SHEATHING 8 FT. BOND BEAM`
• FRAMING/VENTILATION FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING FINISH GRADING
SHOWER/TUB TEST POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING
WALL INSULATION POOL FINAL
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PIT/L.L. ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. � FIRE DEPT. FINAL
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING ENERGY
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COMMENTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE
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Prescri tive Certificate of Com liance: Residential CF-IR-ALT
Residential Alterations Pa e 1 of 5
Project Name: Climate Zone# #of Stories
Tai Ruby 9 1
General Information
, Sit¢Add�¢SS:�pgs paseo De Terrado Ave Dlamond Bar CA 91785 Enforcement Agency:Diamond Bar,City of Date: 11�Z2010
Building Type 0 Single Family O Multi Family Circle the Froot Orientation:�,E,S,W,or degrees
Conditioned Floor Area(CFA): �2� Project Type: �Alterations ❑Envelope Fenestration Roof QHVAC
R lacement or Chan e Out ❑Duct Re lacement ❑Water Heater
NOTE:This jorm is not to be used jor New/y Constructed Buildings or Additions '
Insulapon Values For Opaque Surjaces(/'or Furring use the Mass mrd Furri�rg Strips Construction table below)
Assembly Alteration
❑Opening of framed cavity alone—Alterarions that involve[he opening of the framed cavity ofa wall,ceiling,or�loor must insta(!the
mandatory minimum insu(atian value per§I50 for the altered assembly.Frl1 in Columns A—C and enter mandatory insulation value in Column H.
❑Replacement of entlre assembly—Replacement of an entire wall,ceiling,or jloor assembly requires the installation of Component
Packa e-D insulation va[ues itt Tab(e ISI-C. Fill in Columns A—J.
� a ue SurfaCe Details For the furred ortioned of Mass Walls see Furrin Stri s Construction Table below.
A B C D E F G H I J
� Pro osed `� °�e Standard Values From JA4 Table
� q Framir►g ,� Thicknessa s� � Pramed Continuous JA4 Proposed
Ta�/ Assembly Nai�e �p 1Glateri5l�p"�"{. Sp in (�"�pU- JA44Table" Gavi '� InSulaYion Assembl Assembl
`f v+.rh�C�#S��!��„ t �2�t1�! �ti. ��m,,,�,,�C lSd"p�4�a� � �.%� ���Irt 1���U� � � Y �
ID or T e and'Size orOther3 factor� Numbers' ` R-value R�Va�ue�`y' Cell Valuee U-facto
.�''' �.: `°�. i� ' 1 /�".;sa c n�rr��a r��r,�rt� �nl �r�+ �,e�o+i�{���ir+s�
t'' . ,::�-=�;: ' \� ,e`�'I �rv�v u u r�n �+a� �.+�L a� u�v�+:�r u�a:v��yv,�v� �
�+�',mi��9� �P:<",..A..-��r'���,�;�. �ws�; s�+"�r. ..r x�n�e�,..
�'�.�'�'� �F'�1�°�°"�� k"�` i.s�s�G�'�^- •�-"`°�,��<'�r.��,
Note:For furred arsemblraa"'a"ccounhng for Contriiu'ousPlits7ahon R-value see Pdge JA4 3 and Equdfion 4-I:�;Fo`r.°calcu/aling jurred walls use the Mass and
Furrin Construction iable belo�� ' ��''.,ti,",� . � . f l� ' „„ray�� �""". �yA�
1.Far Tag/ID indicate''tlie i,Tde�il��ion nm�re[hatlmatches the budduig plans �,�. $� � '� �"��' �.�
2.Indicate the Assembly Nume ar type•Roof/,Ceilr g�.Wa!!s F/oors Slabs,4Crawl Sp ce,aDoors a�d etcj bidicat" e 1he3Frameitype and Size:For i
ue
Wood,Metal,Metal Buildings,Mass,enle"r�2s4�2x6;;or etc-�;see JA.4 for otherpossrb+le frame%��assemtilies^ � 4 � � ,
y�;,=�"� ''°�t,�r.sw��'�'�.�;��... ='.,",�a«". '�L°'Fn � :ar ,,Mw.y,.
3. Enter[he thickrress for mass in inches or Spactng between frcaning-members enter, 16 o`r-24 OC;o�Other for all other`arsembly description
se�ch us Concrete Sandwich Panel,Spundre!Panel,Logs,S!aw Bnle Pane!and etc.... "�� � �
n,.., '�
4.Based on the Climate Zone;ente�the Standard U factor fro,rn-Tab/e�151-B, C or D for each different arseriibfy.N me�or.rype.
5.Enter the Table number(hat closely resembles the proposed assemb/y.
6. Enter the R-value that is being inrtalled in the wall cavity or behveen the framing;otherwise,enter"0".
7. Enter the Continuous Insulation R-value for the proposed assembly;otherwise,enter"0".
8.Enter the row and column of the U factor value based on Column F Tab(e Number and enter die Assembly U factor in Column J
9.The Proposed Assembly U factor, Column J,must be egual to or less th�the Standard U faclor in Column E to comply.
Furrin Stri s Construction Table for Mass Walls Onl
A B C D E F G H I J K L M
Proposed Properties of Masonry and Concrete Added Interior or Exterior Insulation
Walis From Reference in Furring Space from Reference
Joint A endix Table 43.5 4.3.6 43.7 Joint A endix Table 4.3.13
°�' o �` °' `'� �' a,
U � '� .� W 5'i ��r V
A p � O.� io
Assembly �ev � o .g.� �' F� o �a� � >;, Final
Mass Name or JA4 Table �.� � � ^° � g $ �� '� � a � '� AssemblY
Thickness' T = Number' <> � " x � � � ' Q> � ' U-factor67 Comment
Registralron Number.• 310-A0001083A-000000000-00p0 Regis�ration DatelTrme: 1��02/2010 09:23:45 HERS Provider.• CBPCA
2008 Residential Compliartce Forms August 2009
Prescri tive Certificate of Com liance: ResidenNal CF-IR-ALT
Residential Alterations Pa e 2 of 5
Project Name: Climate Zone# #of Stories
Tai Ruby g �
ass and Furrin Stri s Construction ootnotes
1.Indicate the type of assembly to include;Hollow Unit Masonry Walls,Solid Unit Masonry,Solid Concrete Walls,Etc. Additional assemblies can
e found Rejerence Joint Appendix JA4.
. Thu is the U-Factor based on the thickness ojthe assembly in inches.
. The R-value of the insulation to be added on the interiar or e,rterior of the assemb(y.
. The Calculated R-Yalue is the R-value of the furred out section of the assembly.
.-6.The Fina!Assembly is calc7�laled using Equation 4-2 or Equation 4-4of the Reference Joint Appendix JA4. Tl:e equatiait is the imerse of Column
added to Column L Col:�mn K is 1/:e inverse from column J.
7.�nserJ!he calculated U-aclor value on to!he O ue Su ace Details in Column J
FENESTRATION PROPOSED AREAS
❑Re[/18Cing wlndOw 810I1e—Replacernent windows shull meet the U-Faclor and SHGC Yalue requirements of Componenl Package D in
Table I51-C. The Toml Fenestration and West facingArea requirements are not applicable.
❑Adding SOftZ Or less of wirtdOw 8Ce8—Newly installed windows shall meet the U-Factor and SHGC Value requirements of Component
Pack4ge D i�r Table ISI-C.
❑Adding mOCe than SOftZ of WiI1dOw a�ea— Newly insta!!ed windows sha(!meet Ihe U-Factor and SHGC Value and the Fenestralion
Area requirements ojComponent Package D in Table 151-C.Complete!he Altered Fenestration Allowed Area Tab1e on Page Z of the CF-IR-ALT
Q Orientation�'. � �� �,� ��
�d?4��p�'tr�117'�qn tt� rt� Maxunum
Fenestration�Type[and�Eramett y� ��(North��East�;�(P,�opsedArear���_ � �Ma�cimum NFRC or Default
Window G1ass:Door'or S li ht c•-�-•••-y rsSouth,West �' ,f� �U-factotZ'3 SHGC�d4 ValueS
�r o;f��., , '� $ ' �.,;.� ��'l�}��'��14�C��� ����'��'�'�����
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1.Fenestration areu is the area of total glaze"d product,((t e'�gla'ss plus fra`me) Fxcephon`�"�hen`a door is less_1han+50%;gla"s's,the,fenestration
area�nay be the glass area phts a '2 tnch fra�ne arotind the gluss. � �� ��` �` � �,q�"��`p
��..,-..,.-�``�,.�,.=s��''� �. ,
2.Enter value from Component Package D Requtreme u n Table 1 SI;C. �W � + :� �
3.Actual fenestration producGs installed mrd as indtcated in CF-6R-ENV Fonn shall be equivulent to o�have a�lowe�U,fbctor and/or a lower
SHGC value than that spee�ed on the CF-1R ALT Form. �;,,� ��'�,•���
4.Submit a completed WS-3R Fonn ija reduced SHGC is calct�(ated with exteriar shading. �I
S.I a licable at this sta e enter"NFRC" or NFRC Ceni ied wrndows or are CEC"D mdt"va/ues ound in Table 116-A or B. I
ALTERED FENESTRATION ALLOWED AREAS(Com lete i more than SO o errestradon is added)
A B C D E F G
Allowed Existing Fenestration Total Area
CFA of Eutire %of Fenestration Area Fenestration Allowed Proposed AreaZ
Dwelliu CFA Area Removed Area Added A x B E-D +C
Total Fenestration Area
� .20 >
West Fenestration Area
(Required In , .OS >
CZ's2 4&7-15 —
1. West Fenestration Area incl:�des west-sloping skylights and arry skylighls x�ilh a pitch less tl:un 1:12.
2. West facing glcair:g m�ea removed cannot be "counted"twice." In order to distribute the west glazi�7g area removed to the other orienlaRions,
inpr�t[he west glazing area removed in the Tota!Fenestratio�:Area rox;column D.
3.Include the Praposed Area of the West jacing fenestration in both Area columns below.
4. To meet com liance,the Pra sed Area must be less thrm or e ual!o the To1al Allowed Area or BOTH the Total and West Fenest�ation Areas.
Registration Number: 310-A0001083A-000000000-0000 Reg'rstralion DatelTime.• 11/Q2/2010 09:23:45 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
Tei Ruby 9 1
ROOFING PRODUCTS(COOL ROOFS)§151(�12
R'hen the area of ezterior roof surface to be replaced e�ceeds more than SO%of the existing roof area,or more than 1,000 ,whichever is
less,the new roofing area musl meet the roofing product"Cool Roof'requirements oj§I52(b)IHi,152(b)lHiy or 152(b)IHiii.
Check applicable alternative or ezcepHon below if!he roof alteration is exempt from the roofrngproduct "Coo!Roof'reguirements.Note:lf any
one of ehe alternatives or exception below is checked,the Aged Solar Reflectance and Therma!Emittance requirements for roofrng producu in
§118(i)are not applicable.Do no!fr!!table below.
❑Cool Roofs�1Qt 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 Slb/ft.
Alternatives to§152(b)1Hi and§152(b)Hii,Steep-slope roof(pilch>l:ll)
❑ Insulation with a thermal resistance of at least 0.85 hr•ft�°FBtu or at least a 3/4 inch av-space is added to the roof deck
over an attic;or
❑ Existing ducts in t6e attic are insulated and sealed according to§151(�10;or
❑ In climate zones 10,12 and 13,with 1 ft 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 radiant bamer in the attic meeting the,requiremen Qf§151(�2;or
�""',.��J��{S�„.5.
❑ Building has no ducfs•ti�the athc,or��� ���� �,� ����������i
�*aw s+L tia ea
O In climate zones 10�11;�13 and.14 R 3 orxgr�,eat�er roo,�deck insulation alio e vented attic. � ,�
Exception to§152(b)��ii���°"��lo�roof�(,P�r�tqcH<2�.�,12}"����""��'���� �t�,�"���*�'�`���
❑ Building has nosducts,m the athc��,;.:;" ,,�
Other Exceptious������ � ���~..�: V :� "�. ' -�.,�" �.�.
❑Roofing area cov,4eredrby,�building;inte�ated photovo\ta�e panels and solar therm�p els�are,ez pt from the below Cool Roof criteria
� . _. ta�,:� �
❑Roof constructions;th"at'have�t6ermal mass:over,the roo.frriembrane with attleast.25�1b/ft is exem t'from the�below;Cool Roof criteria.
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Note:If no CRRG1 label'is'available,this corri'liance metliod"cannot be used use the�Performance Appmach to show,"compliance,otherwise,
Check the a licable bo lielow if Exem Yt.:',fc•"omtithe Roofin""rProducts`Cool'PRooP�rRe uirement: .�'�"`�'�,�
���. '",�_ �w u'�.�. ,�•�: F�a+w;^.,r �M"�;`ti.w�0k°�,' °"vr' .�k5'"rµ' T:
�Roof�Slope���}'P� Product Weighti�d" m�Rroduct.� �Age,dqSolarar.v 'Thermal
CRRCProductIDNumberl < 2 12'�.e>_2.12 i�'�< Slb%ft;ti>.,SIb%ft`�T�v �,��Reflectauoe34� ,:Emittance SRIS
_� ❑ � , . �f p ❑� `�-.,..�-°'� � �.-*���
❑ ❑ �—p ❑ p4 -�•' "..�-w.""
0 ❑ ❑ ❑ ❑4
❑ ❑ ❑ ❑ �a
❑ ❑ ❑ ❑ ❑4
I. 77re CRRC Product ID Number can be obtained jrom the Coo!RoofRating Council's Ra[ed Product Direclory a!www coolroojs osy/producls/search�
2.lndicate the type oJproduct is being used for!he roof top,i.e.single p!y roaf,aspha!!roof,nreta!roof,e[e.
. If the Aged ReJlectance is nol avai(able in the Coo!RoojRating Council's Ra�ed Product Directorv lhen use the Initia!ReJlectance value from!he same
directory and use the equation(01+0.7(p���—0.2)!o obtain a calculated aged va/ue. Where p is!he Inilial Solar Reflectartce.
.Check boz ijthe Aged ReJlectance is a calculated value using Ihe equation above.
Calculate!he SRl value by using!he SRI-Workrheet a(htf�:/hvww.energv ca.Yov/!i(/e�4/and enter fhe resul[ing va/ue in!he SRI Column above cmd a!lach acopy of
the SRI-Worksheet(o the CF-IR.
o 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.• 310-A0001083A-000000000-00p0 Registration Date/7'ime.• 1��02/2010 09:23:45 HERS Provider: CBPCA
2008 Residential Comp/iance Forms August 2009
Prescri tive Certificate of Com liance: Residential CF-IR-ALT
Residential Alterations a e 4 of 5
Project Name: Climate Zone# #of Stories
Tai Ruby 9 1
HVAC SYSTEMS-HEATING
Minimum Duct or Piping Configuration
Heating Equipment Efficiency Distribution Iusulation 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,57000 95 AFUE Ducted, 4.2 SetBack Split
1.Indicale Heating Type(Central Furnace, Wul!F��rnuce,Heut pump,Boiler,Electric Resistance,etc.)
2.E/ectric resistance heating is allowed only in Component Package C,or except where e%ctric heating is supplementa!(i.e.,ijtotal cupacity
<2 KW or 7,000 Btu/hr electric healing is controlled hy a time-limiting device not exceeding 30 minutes). See�151(b)3 exception.
3.Rejer to lhe HERS Verification section on Page 4 of the CF-IR-ALT Form far additianal requirements and check applicable boxes.
4: Indreate Type or Location(Ducts,Hydronic in Floor,Radiators,etc.) ,
HVAC SYSTEMS-COOLING
Minimum
Lfficiency Duct or Piping Configuration
Cooling Equipment (SEER/EER or Distribution Insulation Thenrtostat (Central,Split,
' T e and Ca ci '�2 COP T e and Location3 R-Value T e S ace Packa e or H dronic
� AirConditioner,�6000,�. ,� 15 SEER ,� p�cte�;,. ;;�, 42 ,�. SetBadc Split
�'��� ��� ���� ,����;��'���� ���� ��� ��������
1.Indicate Cooling Type(A%C�Heat pump,E.v�Cooling,etc) � �q�, + •
� ^�d�sr�sear�.�a. �e ��f'�"��'�R dP°4°�, �'*i�"' �l�'��IR"+A"_"��`�'.4i�°R�'
2.Refer to the HERS1r�Y�enf,r�a��ectron�on�,P,�age��4 o�f�the GF„IR-�1L_'T�,Fon,,,n;for7aildidio„nal�eqUir,,_emenls�cmd�cheq„sl�applt.�able�oxes.
3.Indicote T e or Locatiorr cts,.F!dronic iri,F.loor,Radiators,etc.
� '�,a..,l, � �,.w 'Lr�. .- -'."'��' �"�. �y?��..;.^ �.�f�
I
WATER HEAT�ING�,_. ..�''�-.�'��"�'��� `�' ',f'��'�?`�: ,-,,wY�:�,�:�
List water heaters and�bo'ilers for.�bo;th domestic�liot water(DHW)heaters and hydr'omc'"�pace heating Indrvuhtal 11we/ling DHW heaters must be
+�.°��',�.a�. r..,�,�.r� R � 4 t� s�^t t a ^a?+ aWmss �+nr�
gas or propane fired and'm'aymoi exceed q�g��alylu'o� Hot�wat�ptpe'in�ulat�on�m tlre DHW heater to�he�latc{aen(s)�,%m;d��n all undergrm�nd
hot water i es is r uirerl in all corn onent, acka es,riiY'all:climate�zones: ��:�;��,��.��=�'�`�r�hskn,�"�.,'r?�,�'� �
� :.;, Yl� N ;3-� .°- �,. - � < ,.._��„ �, Exte�nal Tank
_ _ .. r� �.� , ;�,�';� ��,�.a--�,
Water Heater T elFuel D�stribu�T e �p umber In �""`'-Taok Energy Factor or�' Insulation
T e� Standard,Recirculatin 2 ' � :7 S stem Ca aci al „ Thectnal4Efficienc� R-Value3
�:;�;.+a,� ��' L���.
1.Indicate TyPe(Storage Gas,Heat Pump,Instmltcmeous,etc.)
2.Recirculating systems serving mu/1iple dwelfing units sha!(meet the recirculation requirements of§I SO(n). The Prescriptive requirements do
nor allow lhe insta!lalion of a recircula[ing water healing system for single dwelling unils.
3. The external water healin tank and ' es sha(1 be insulated to meet the re uirements o 1 SO '.
SPECIt�T.T+'EATLIRE.S'Ilie enforcement agency should pay special attentio�t to the Specia!Features spec�ed in lhis checklut below.
These ilems re uire wril�en 'us�i rcation and doctirmenJaJion and s ecia/veri ation.
NEW ROOF ASSEMBLY-Radiant Barrier
1'he radiant barrier re uirement of 151 2 does not 1 to roof alterations.
Slab Edge(Perlmeter)Insulation 0 YES 0 NO
YES:In Climate Zone 16 in Camponent Packages D,R-7 insulation is required.
Heated Slab Insulatlon �YES 0 NO
YES:Slab ed e insulatiou r uired for all heated slabs iu all Climate Zones. See details in Table 118-A of the standards.
Raised Siab Insulation �YES �NO
YES:In Climate Zones 1 2 11 13 14&16 R-8 insulation is re uired•in Climate Zones 12&15 R-4 is re uired under com onent Packa e D.
Thermal Mass
To obtain Com liauce Credit for the installation of thermal mass,use the Performance A roach.
Registration Number. 310-A0001083A-000000000-OU00 Registration DatelTime: 11/�2/2�10 09:23:4�J HERSProvider: CBP�'A
2008 Residential Compliance Forms August 2009
.t . . I
Prescri tive Certificate of Com liance: Residential CF-IR-ALT
� Residential Alterations - a e 5 of 5
Project Name: Climate Zone# #of Stories
Tai Ruby 9 1
HERS VERIFICATION SUMMARY The enforcernent agency shor�ld pay specia!attention to the HERS Measures specified in this
checklist below. A completed and signed CF-4R Fonn for a!!the measures specired sha((be submitted to the building inspector befare fina(
ins ection.
Duct Sealing&Testing HERS verrfication is required for lhis measure.
�YES �NO YES:In Climate Zones 2 and 9-16,if more than 401inear 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.
O EXCEPTION:Existing duct systems that are extended,which are constructed,insulated or sealed with as6estos.
�YES 0 NO YES:In Climate Zones 2 aad 9-16,if the existing space-conditioning system(HVAC equipment and ducting)is replaced,the
ducts are to be sealed per§152(b)1Di.
�YES �NO YES:In Climate Zones 2 and 9-16,if the exisring FIVAC equipment is replaced(including the replacement of the air handler,
outdoor condensing unit of a split system,cooling or heating coil,or the fumace heat exchanger)the ducts are to be
sealed per§152(b)lE.
� EXCEPTION:Duct systeros that are docamented to have been previously sealed confirmed through HERS
verification in accordance with procedures in the Reference Residential Appendia�RA3.
❑ EXCEPTION:Duct systems wlth less than 40 linear teet in uncondittoned space.
❑ EXCEPTION:Existin duct stems constructed insulated or sealed with asbestos.
Refrigerant Charge-Split System HERS verificatio�r is required jo�this measure.
�YES �NO ES:In.Climate Zonesr2 and 8-15,when t�existing FIV2.�equipinent is replaced('including the replacement of the air
�°�ba�dl'e�ot�"rt�do�o'�n�dens4 ing"u�udit�o�a�p�t sy�stem A/uC��e�"t p p,�coo��t��ea�'ri g�il,or the furnace heat
,.:exchan er a refri erant char e measu�ement s6alt��be verified er ,t,s2 iF.
m.-. . n� ..� f� L';l c)�rT"a � ^�IFo
Central Fan Integrated(CFn V,entilation�System�and F_an,��,VUy,a�Dra*w ���������.�� �
The veurilarion re uirements of �150 0 .do�not a 1 to exisdu residential homes.
z � �� i 1 ,-� �s �r-.:-�-� .
Ducted Split Systems=�Air Cond�t�oners and�Heat Pumps Airflow HERS venfrcanon u required for this measure.
,
�YES 0 NU YES:'In Climate Zones 10 through,l5,when ihe;ezistmg space condRion�g system(HVAC equipment and ducting)is
.
' '+Y, ,;�r�'laced,,the aiiflo',wA"andFfan watt draw shall�e venfied'. er. ;1�2 b 1Ci t m et,the`re mrcmeuts of 151 7B.
'�a" c,, ��• �'�. �
.,'��` �'R�, '�_ ,�. � ��-.�.�. ���" ���.� ,� �w" ��.�,
Documentation Author's Declaration�Stateme a, ;�''��.eF�,�"�'� ��;.������`,���' ,:,;;;,,����':��
• I certi that this Certificate of Com'llance�documentation��'s�accurute;and om lete.��� ,��j���"',,�°"t�`�"���
Name: r' Signature: G;,�` �ti �x o,�
Lymann Lockwood �,'�, ���� Lymann Lockwood ��'�,� � I
Company:George Heney&Son,Inc Date: ���p
Address: ���E.Colorado st. If Applicable CEA or CEPE
(Certification#):
City/State/Zip: P6one:
Glendale Califomia 91205 g�g_2qg-42gq
Responsible Building Designer's Declarafioo Statement
• I am eligible under Division 3 of the Califomia Business and Professions Code to accept responsibiliry for the building design idenrified on
this Certificate of Compliance. ,
• I certify that the energy features and performance specificatioas for the building design identified on this Certificate of Compliance conform
to the requirements of Title 24,Pazts 1 and 6 of the Califomia Code of Regulations.
• The building design features identified on this Certificafe of Compliance are consistent with the informarion provided to document this
building design on the other applicable compliance forms,worksheets,calculatioos,plans and specifications submitted to t6e enforcement
a enc for a roval with this buildin ermit a fication.
Name: L mann Lockwood Signature:
Y Lymann Lockwood
Com n
� y� George Haney&Son,Inc Da�� 11/2/2010
Address: License: 329449
1104 E.Colorado st.
City/State/Zip: Glendale Califomia 91205 Pb��e� 818-243-4264
For assistance or questions regarding the Energy Standards,contact the Energy Hotline at:1-800-772-3300.
Registration Number: 310-A0001083A-OOOp0000Q0000 Registraliort DalelTirne: 11/�2/2�10 09:23:4J HERS Provider.• CBPCA
2008 Residential Comp/iance Farms Ai�gust 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:
23085 Paseo De Terrado , Diamond Bar, CA 91765 City of D(amond Bar 10-1069
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 (zCF-1R space, Duct Load Capacity
heat um and Model Number Number z S stems value° etc. R-value tu%hr Btu/hr I
Gas Flred Ceniral York PG9SO60B12MP11A 3475362 1 95 Walls 42 45000 57000 �
Fumece
Cooling Equipment
Efficiency Duct
, E4u�p (SEER Location
, TYpe and EER) (attic,
(package #of �'3 crawl- Cooling Cooling
heat CEC Certified Mfr.Name ARI Reference Identical (>_CF-1R space, Duct Load Capacity
um and Model Number Number z S stems value ” etc. R-value (Btu/hr tu/hr
Split A/C System YORK YCJF36S41S1A 3475362 1 5=15 E=72.5 Walls 4.2 32000 36000
I.Ifproject is new construction,see Footnotes to Standards Table I51-B and Table ISI-C for duct ceiling alternative
compliance.
2.ARIReference Number can be found by entering the equipment model number at http://www.aridirectory.org/ari/ac.php#
3.Listed e�crency on this page must be greater than or egual(>)to the value shown on the CF-IR 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-§1 13:HVAC equipment is certified by the California Energy Commission.
0✓ §150(h):Heating and/or cooling]oads calculated in accordance with ASHRAE,SMACNA,or ACCA.
� 0 §150(i): Setback Thermostat on a11 applicable heating and/or cooling systems meet the requirements of§112(c).
� §I50(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:
23085 Paseo De Terrado , Diamond Bar, CA 91765 City of Diamond Bar 10-1069
Ducts and Fans
§I50(m):Duct and Fans
✓� 1.All air-distribution system ducts and plenums installed,sealed and insulated to meet the requirements of CMC
Sections 601,602,603,604,605 and Standard 6-5;supply-air and return-air ducts and plenums are insulated to a
minimum installed level of R-4.2 or enclosed entirely in conditioned space. Openings shall be sealed with mastic,tape
or other duct-closure system that meets the applicable requirements of UL 181,UL 181A,or UL 181B or aerosol
sealant that meets the requirements of iJL 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 sea]ed sheet metal,duct board or flexible duct shall not be used for 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-sectiona]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.Exhaust fan systems have back draft or automatic dampers.
0✓ 8.Gravity venti]ating systems serving conditioned space have either automatic or readily accessible,manually
operated dampers.
❑� 9.Protection of Insulation.Insulation shal]be protected from damage,including that due to sunlight,moisture,
equipment maintenance,and wind.Cellular foam insulation shall be protected as above or painted with a coating that is
water retardant and provides shielding from solar radiation that can cause degradation of the material.
❑✓ 10.Flexible ducts cannot have porous inner cores.
DECLARATION STATEMENT
• I certify under penalty of perjury,under the laws of the State of Califomia,the information provided on this form is true and correct.
o 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-1R)form approved by the enforcement agency that identifies the specific
requirements for the installation. I certify that the requirements detailed on the CF-1R that apply to the installation have been met.
• I will ensure that a completed,signed copy of this Installation CertiTicate shall be posted,or made available with the building
permit(s)issued for the building,and made available to the enforcement agency for all applicable inspections. I 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)
George Haney&Son, Inc
Responsible Person's Name: Responsible Person's Signature: ����
Lyman Lockwood
CSLB License: Date Signed: Position With Company(Tide):
329449 11/3/2010 8:5825 AM Administration
2008 Residential Complrance 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:
23085 Paseo De Terrado. �iamond Bar, CA 91765 City of Diamond Bar 10-1069
Enter the Duct System Name or ldentificationlTag: Duct System 1 I
Enter the Duct System Location or Area Served: Walls
Note: Su6mit one Installation Certificate for each duct system that must demonstrate compliance 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 reptacement duct system can also include existing parts of the originat
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 ezisting dwelling, use the Installotion Certif:cate titled"Duct
Leakage Test—Completely New or Rep/acement 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 2.Measured leakage to outside less than 10%of Fan Airflow.
❑Option 3.Reduce leakage by 60%or more,and conduct smoke test to seal all accessible leaks.
❑Option 4.Fix all accessible]eaks using smoke test,and HERS rater must verify. �
Note:(Option 1 must be attempted before utilizing Option 4)
Deterrnine nomina]Fan Airflow using one of the following three calculation methods.
❑Cooling system method: Size of condenser in Tons 3 X 4OO= 12� CFM
�Heating system method: 21.7 x 57 Heating Output Capacity(kBtuh) _ �236.9 CFM
❑Measured.system airflow using RA33 airflow test procedures: ° CFM
Option 1 used then:
Allowed]eakage=Fan Airflow 1237 x 0.15= �es.ss CFM
1 Actual]eakage= 138 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 0 Fail
Option 3 used then:
Initial leakage prior to start of work= CFM
Final leakage after sealing al]accessible leaks using smoke test= CFM
3
Initia]leakage -Final leakage =Leakage reduction CFM
(Leakage reduction /Initial]eakage )x 100%_%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❑Fai]
Regrstration Number.• Registration Da(e/Time.• HERS Provider:
2008 Residential Compliance Forms Augus12009
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:
23085 Paseo De Terrado , Diamond Bar, CA 91765 City of Diamond Bar 10-1069
�
O Outside air(OA)ducts for Centra]Fan Integrated(CFn 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 I
during duct leakage testing. I
O All supply and return register boots must be sealed to the drywall if smoke test is utilized for compliance—applies to �
duct leakage compliance option 3 (leakage reduction by 60%)and option 4(fix all accessible]eaks)described above.
❑O New duct installations cannot utilize building cavities as plenums or platform retums in lieu of ducts. �
0 Mastic and draw bands must be used in combination with cloth backed rubber adhesive duct tape to seal leaks at all new
duct connections.
DECLARATION STATEMENT
• I certify under pena]ty 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 specificarions approved by the
enforcement agency.
• I understand that a HERS rater will check the installation to verify compliance,and that that if such checking identifies defects,I am
required to take corrective action at my expense. I understand that Energy Commission and HERS provider representatives will also
perform quality 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
addirional checking/testing of other,installations in that HERS sample group will be performed at my expense.
• I reviewed a copy of the Certificate of Compliance(CF-1R)form approved by ihe enforcement agency that identifies the specific
requirements for the installation. I certify that the requirements detailed on the CF-IR 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 inspecHons. 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 1,2010,for all]ow-rise residential buildings.
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
George Haney & Son, Inc
Responsible Person's Name: Responsible Person's Signature:
Lyman Lockwood ��_
CSLB License: Date Signed: Position With Company(Title):
329449 11/3/2010 8:59:20 AM Administration
Is this installation monitored by a Third Party Quality Control Name of TPQCP(if applicable):
Program(TPQCP)? pYes ❑No Enalasys
Registration Number: Registration Date/Time: HERS Provider.�
2008 Residential Compliance Forms August 2009
INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS
Refri erant Char e Verification-Standard Measurement Procedure a e 1 of 5
Site Address: Enforcement Agency: Permit Number:
23085 Paseo De Terrado , Diamond Bar, CA 91765 Ciry of Diamond Bar 10-1069
Note:If installation of a Charge Indicator Display(CID)is utilized as an alternative to refrigerant charge verif:cation for
compliance, a MECH-24 Cert:ficate(instead ojthis MECH-25 Cert:ficate)should be used to demonstrate compliance with
the refrigerant charge verification requirement. TMAH and STMS are not required for compliance, when a CID is utilized
for compliance. ,
As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additionaJ form(s)for
any additional systems in the dwelling as applicable.
Temperature Measurement Access Holes(TMAI�and Saturation Temperature Measurement Sensors(STMS)
Procedures for installing TMAH are specif:ed in Reference Residential Appendix RA3.2. If refrigerant charge verif cation
is required for compliance, TMAH are also required for compliance. STMS are only reguired for completely new or
replacement space-conditioning systems that utilize prescriptive compliance method.
TMAH-Access I3oles in Supply and Return Plenums of Air Handler
System Name or ldentification/Tag System 1
System Location or Area Served Ground Pad
1 �Yes pNo 5/16 inch(8 mm)access hole upstream of evaporative coil in the return plenum and
]abeled according to Figure in Section RA3.2.2.2.2.
2 ❑O Yes pNo 5/16 inch(8 mm)access hole downstream of evaporative coil in the supply p]enum
and labeled according to Figure in Section RA3.2.2.2.2.
Yes to 1 and 2 is a pass. Enter Pass or Fail ✓ �Pass ✓ ❑Fail
STMS-Sensor on the Eva orator Coil
System Name or ldentification/Tag System 1
The sensor is factory installed,or field installed according to manufacturer's
3 ❑Yes ❑No specifications,or is installed by methods/specifications approved by the Executive
Director.
The sensor wire is terrninated with a standard mini plug suitable for connection to a
4 ❑Yes ONo digita]thermometer. The sensor mini plug is accessible to the installing technician and
the HERS rater without changing the airflow through the condenser coil
; 5 ❑Yes �No The sensor measures the saturation temperature of the coil within 13 degrees F
Yes to 3,4,and 5 is a pass. Enter �/ O N/A ✓ ❑Pass ✓ ❑Fai]
N/A if ST'MS are not applicable. Otherwise enter Pass or Fail
STMS-Sensor on the Condenser Coil
System Name or ldentification/T'ag 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 �I'es 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 ❑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 .i ❑pass ✓ ❑Fai]
N/A if STMS are not.applicable. Otherwise enter Pass or Fail
Regrslration Number: Registration Date/Time: NERS Provider.•
2008 Resrdential Compliance Forms August 2009
- -
INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS
Refri erant Char e Verification-Standard Measurement Procedure a e 2 of 5
Site Address: Enforcement Agency: Permit Number:
23085 Paseo De Terrado , Diamond Bar, CA 91765 City of Diamond Bar 10-1069
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 R,93.2. As many as 4 systems in the dwelling can be documented jor comp/iance using this form. Anach an
additional form(s)for any additronal systems in the dwelling as applicable.
• The system should be rnstalled and charged rn accordance with the manujacturer's spec f catrons before starting this procedure.
• The system must meet minrmum airflow reguirements as prerequisite for a valid refrigerant charge test.
'• If outdoor air dry-bulb is 55°F or below,the installer must use the Alternate Charge Measurement Procedure.
S ace Conditionin S stems
System Name or ldentification/Tag System 1
System Location or Area Served Ground Pad
Outdoor Unit Serial# W1 G0127301
Outdoor Unit Make YORK
Outdoor Unit Model YCJF36S41 S1 A
Nominal Cooling Capacity Btu/hr 36000
Date of Verification 10/27/2010
Calibration of Dia nostic Instruments
Date of Refrigerant Gauge Calibration (must be re-calibrated monthly)
Date of Thermocouple Calibration (must be re-calibrated monthly)
Measured Tem eratures °
System Name or ldentification/Tag System 1
Supply(evaporator]eaving)air dry-bulb
50.5
temperature(Tsu 1 >db)
Return(evaporator entering)air dry-bulb
77.1
tem erature(Tretum>db) •
Return(evaporator entering)air wet-bulb
tem erature T 57.6
P � retum�wb�
Evaporator saturation temperature
45
�Teva orator>sat�
Condensor saturation temperature
101.1
�Tcondensor�sat�
Suction]ine temperature(TsUctior� 68.3
Liquid Line Temperature(T�;qu;d) 91•8
Condenser(entering)air dry-bu]b
tem erature T 90.4
P � condenser db�
Registration Number.• Registration Date/Time: HERS Provider.•
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:
23085 Paseo De Terrado , Diamond Bar, CA 91765 Ciry of Diamond Bar 10-1069
Minimum Airflow Re uirement '
Temperature Split Method Calculations for determining Minim�m 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=
Tretum>db-Tsupply�db
Target Temperature Split from Table
RA.3.2-3 using Tretum>wb and Tretum�db
Calculate difference: Actual Temperature
Split—Target Temperature Split=
Passes if diff'erence is between-3°F and
+3°F or,upon remeasurement,if between
-3°F and-100�F Enter Pass or Fail
Note: Temperature Split Method Calculation is not necessary if actual Cooling Coi1 Arrflow is verifred using one of the
airflow measurement procedures specified rn Reference Residential Appendix RA3.3. Ijactual cooling coil airflow is
measured, the value must be egua!to or greater than the Calculated Mrnimum Airflow Requirement in the table below.
Calculated Minimum Airflow Requirement(CF1Vn = Nominal Cooling Capacity(ton) X 300(cfm/ton)
System Name or Tdentification/"Cag System 1
Calculated Minimum Airflow 900
Requirement(CFM)
Measured Airflow using R.A33 1164
procedures(CFM)
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
Calculate: Actual Superheat=
Tsuction—Teva orator sat
Target Superheat from Table RA3.2-2
using Tretum,wb and Tcondenser>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
Regis{ration Number.• Registration Date/Time: HERS Provider: .
2008 Residential Compliance Forms August 2009
INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS
Refri erant Char e Verification-Standard Measurement Procedure a e 4 of 5
Site Address: Enforcement Agency: Permit Number:
23085 Paseo De Terrado , Diamond Bar, CA 91765 City of Diamond Bar 10-1069
Subcooling Charge Method Calculations for Refrigerant Charge Verification. "This procedure is reqn'ued to be used
for thermostatic expansion valve(TXV)and electronic expansion valve(EX�systems.
System Name or ldentification/Tag System 1
Calculate: Actual Subcooling=
9.3
Tcondenser sat—Tli uid
Target Subcooling specified by 10
manufacturer
Calculate difference: ��
Actual Subcoolin —Tar et Subcoolin =
System passes if difference is between Pa�
-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 e]ectronic expansion valve(EX�systems.
System Name or ldentification/Tag System 1
Calculate: Actual Superheat =
23.3
Tsuction —Teva orator sat
Enter allowable superheat range from 4-25
manufacturer's specifications(or use range
between 4°F and 25°F if manufacturer's
s ecification is not available
System passes if actua]superheat is within
the allowable superheat range PBSS
Enter Pass or Fail
�
Registration Number: Regrstratron Date/Time: HERS Provider:
2008 Resrdential Comp/rance Forms ' August 2009
� ,
` INSTALLATION 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:
23085 Paseo De Terrado Diamond Bar, CA 91765 City of Diamond Bar 10-1069
Standard Charge Measurement Summary:
System shall pass both refrigerant charge criteria,metering device criteria(if app]icable),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 ldentificaUon/Tag System 1
System meets all refrigerant charge and Pass
airflow re uirements. Enter Pass or Fail
DECLARATION STATEMENT
• I certify under penaity ofperjury,under the]aws of the State of Califomia,the information provided on this form is hve and correct.
• I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction,or an authorized
representative of the person responsible for construction(responsible person).
• I certify that the installed features,materials,components,or manufactured devices identified on this certificate(the installation)
conforms to all applicable codes and regulations,and the installation is consistent with the plans and specifications approved by the
enforcement agency.
• I understand that a HERS rater will check the installation to verify compliance,and that that if such checking identifies defects,I am
required to take corrective action at my expense. I understand that Energy Commission and HERS provider representatives will also
perform quality 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-IR that apply to the installation have been met.
• I will ensure that a completed,signed copy of this InstallaHon CertiGcate 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 InstallaHon 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 I,2010,for ail low-rise residentia]buildings.
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
George Haney&Son, Inc
Responsible Person's Name: Responsible Person's Signature:
Lyman Lockwood �D�?�
i�
CSLB License: Date Signed: Position With Company(Title):
329449 11/3/2010 9:00:19 AM Administration
Is this installation monitored by a Third P Quality Control Name of TPQCP(if applicable):
Program(TPQCP)? /Yes ❑No Enalas s
Y
Registration Number: Regishation Date/7'ime: HERS Provider.•
2008 Residential Compliance Forms August 2009