HomeMy WebLinkAbout2015-3236 signedCity of Palm Springs
BUILDING PERMIT
riGog,;. Building Address: 71 Westlake Cir
Date 09/17/2015 Case No.
Submitted
Owner Address Phone
Pat Yantis 71 Westlake Cir 760 324 1971
Palm Springs CA
Contractor Address Phone
Esser Services 3665 Bankside, Cathedral City 760)324-0550
Architect Address Phone
Engineer Address Phone
Lot # Block # Tract Building Address
71 Westlake Cir
Lot Size Zone Occupancy
Permit Denise Bystrzycki
Technician
Lic. Number
489046
Parcel Number
681-050-014
Building Sq. Ft. Garage/Carport Roofed Patio/Porch Remodeled Area
Use of building Permit Type
condo Mechanical Equipment Change -out
Fire Sprinkler Units Valuation Permit Fees Paid
14000.00 137.77
Describe work in detail:
Replace 5 ton a/c, coil, & 100k btu furnace - a/c on ground.
Special Conditions:
Const. Type Fixture Units
HERS duct testing required prior to final
inspection. Setback thermostat required.
Rooftop mechanical equipment must be on
minimum six inch high sheet metal covered
platforms or other approved support. Condensate
lines must be in hard copper.
Refrigerant service ports located outdoors shall be fitted with locking -type
tamper -resistant caps. C.M.C. 1106.3.1
DO NOT CONCEAL OR COVER ANY CONSTRUCTION UNTIL THE WORK IS INSPECTED
IMPC)PTANT
The issuance of this permit shall not be held to be an approval of the violation of any provisions of any city or county ordinance or state law.
Inspections of work are subject to an approved set of plans being on the job. Changes to plans are not to be made without permission of the Building and
Safety Divisions.
The owner and/or contractor is responsible for establishing all property lines. All utilities must be underground.
This permit will expire if work is not started in 180 days or if more than 180 days elapses between
inspections.
I certify that I am familiar with all requirements of the City of Palm Springs as they apply to this permit and understand that these requirements must be
completed priorto final inspection and that no certification of occupancy will be issued until such time as these requirements are met. I certify that I have
read this application and state that the information is true and correct. 0 1
OWNEWCONTRACTOR/AGENT OgATE'/ fS9l1ED BY
This is a Building Permit when properly filled out, signed and validated, and is not transferable.
PERMITNUMBER
Finaled
2015-3236
0
•
INSPECTION INFORMATION
No work shall be concealed without a signature by the
inspector.
The approved plans and this card must always be
available to the inspector. Preserve this record.
A permit shall expire and become null and void if
substanial work is not commenced within 180 days, or
if the work is suspended or abandoned for a period of
180 days. If the work is progressing but approaching
the end of the 180 day period from the last recorded
day of a passed inspection, a progress inspection must
be obtained to keep an active permit.
CONSTRUCTION HOURS
Weekdays 7am to 7pm
Saturdays 8am to 5pm
Sundays & Holidays Not Permitted
JOB NOTES:
JOB CARD
Project address: 71 Westlake Cir
Permit #: 2015-3236
Inspection hours 8AM - 4PM Monday - Thursday
Inspection request line (760) 323-8243
Building Department (760) 323-8242
Building Department Fax (760) 322-8342
MECHANICAL CHANGEOU INSPECTIONS
AC/Compliance Forms Fina
BUILDING PERMIT APPLICATION
DATE: September 17, 20 PLAN CHECK DEPOSIT FEE:
Project Address 71 Westlake Circle
Owner's Name Pat Yantis
Owner's Address SAME
Assessor's Parcel #
Phone # 760-324-1971
Contractor's Name Esser Services Inc. Phone # 760-324-0550 Llc# 489046
Contractor's Address PO Box 1636 Cathedral City, CA 92235
Architect's Name Phone # Lic.#
Architect's Address
Engineer's Name Phone #
Engineer's Address
CONTACT PERSON Michael Esser Address
PHONE 760-324-0550 FAX
Lot Size (sf.)
EMAIL
Lic.#
Building Use Type of Const. Occupancy Groups) Sprinkled
Project Square Footage: Building Garage Carport Patio (type)
Project Description Replace 5ton A/C, Coil, & 10OK BTU Furnace -A/C Is On Ground Total Value of Work $ 14,000.00
WHERE INDICATED BY A CHECK, SUBMIT 3 SETS
(Minimum size of plans *18 x 24" Minimum scale'/4"=1';Maximum size of plans 40" x 36")
® Complete Application.
❑ Plot Plan with lot square footage.
❑ Drainage Plan: show lot corner elevations.
❑ Structural Calculations, if applicable
(wet -stamped and signed)
❑ Floor Plan, dimensioned. Door & Window
Schedule
❑ Framing Plan with sections and elevations
❑ Truss Calculations and layout as applicable
(wet -stamped and signed.)
❑ Foundation Plan
❑ Electrical Plan/Load Calculations include
8-KW future for new single dwellings
and condos
❑ Waste, Drain & Vent Isometric
❑ Gas/Water Piping Isometric (dimensioned layout)
❑ Details showing compliance with accessibility.
requirements
❑ Site Plan showing parking for persons with
disabilities and path of travel to building entrance
❑ Title 24 (Energy) — 2 sets/ Lighting Compliance
Forms
❑ Manufacture's brochure for HVAC equipment
❑ Mech. Plan / Duct Schematic, equipment location
❑ Fireplace Specifications, if applicable
❑ Planning / Fire / Engineering approval
❑ Health Department approval
If your plan is sent to an outside plan check firm, you may choose from the following:
❑ ESGIL Corp. ❑ RKA Consulting ❑ Fazekas & Associates
Bldg. Plan Check #.
Planning Case #_
❑ Regular Plan Check
❑ Expedited Plan Check
Signature
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OWNER / BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason (Section 70 31,5, Business and
Professions Code: Any city or county which requires A -permit to construct, alter, improve, demolish, or repair any Structure prior to its issuance; also
requires the applicant for such permit to'file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's License Law
(Chapter 9 commencing with Sec. 7000 of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom 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).) Please check one of the following:
❑ 1, as owner .of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not
intended or offered for sale (Sec. 7044 of the Business and Profession Code: The Contractor's,License Law does not apply to
an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own
employees, provided that such improvements are not intended or offered far sale. If, however, tke building or improvement is
sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for
the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 704-4 of the
Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves
thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ I am exempt under Sec. of the Business and Professions Code for this reason.
Owner Signature: Date:
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, and my license is in full force and effect. The following applies to B contractors only:
I understand thelimitations of Section 7057 related to my ability to take prime contracts or subcontracts involving specialty trades.
License Class: CZ0 State Lic. No.: 9e,9 () (o City Bus. Lic. No .
Print Name on License:C_ eC' <�;ry�e Phone: 7 b0-32�F Q�S f]
Address: C� I�o7c Ito3(�, 0i�1�ec�rc_� CIA-y CA,
Every county or city which requires the issuance of a permit as a condition precedent to the construction, alteration, improvement, demolition or repair of
any building or structure shall require that each applicant for the permit sign a declaration under penalty of perjury verifying workers' compensation
coverage or exemption from coverage as required by Section 19825 of the Health and Safety Code. I, hereby affirm under penalty of perjury one of the
following declarations:
❑ "I HAVE AND WILL MAINTAIN A CERTIFICATE TO SELF INSURE for worker's compensation as provided for by Section 3700
of the Labor Code, for the performance of the work for which this permit is issued.
I HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, as required by Section 3700 of the Labor Code
for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number
are:
Carrier: Policy No. C�25Z55I C
❑ I CERTIFY that in the performance of 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
-t a worker's compensation provisions of Section 3700 of the Labor Code, 1 shall for with comply with those provisions.
Contractor or Agents Signature: Date: 7%f
Dicr Incnra Pnrrn r ,+-CD-1., c.a___ r+e
N,
CERTIFICATE OF VERIFICATION
CF311MCH-20-H
Duct Leakage Diagnostic Test
(Page I of 3 )
Project Name: PATYAN11S
Enforcement Agency- City of
Palm Springs
Permit Number:
2015--3236
Dweffing Address: 71 WESTLAKE CIRCLE
City: Palm Springs
Zip Code:
92264
A. System Information
01
Space Conditioning System Identification or Name
System 1
02
Space Conditioning System Location or Area Served
Location 1
03
1 Building Type from CF-111
Single family
04
Verified Low Leakage Ducts in Conditioned Space
No, credit is not taken
(VLLDCS) Credit from CF1R?
05
Verified Low Leakage Air Handling Unit Credit from
No, credit is not taken
CF1R?
FDu
F
Duct System Compliance Category
Alteration
Amip'l
S. Dud Leakage ENagnostic Test Mk 7: 7 F-7, 77 1 7' 1 77 F7 7,
01
Condenser Nominal Cooling Capacity (ton)
5
02
Heating Capacity (kBtu/h)
0
03 1
Conditioned Floor Area served by this NVAC system (ft2)
2604
04
Duct Leakage Test Condition
Test final
05
Duct Leakage Test Method
Total leakage
06
Leakage Factor
0.15
07
Air Handling Unit Airflow (AHUAirflow) Determination
Method
Cooling system method
08
Measured AHUA1rfiow
This field or section is not applicable
09
Calculated Target Allowable Duct Leakage Rate (cfm)
300
10
Actual duct leakage rate from leakage test measurement
(cfm)
271
11
1 Compliance Statement: System passes leakage test
Registration Number: 215-A6328851A-M2000002A-M20A Registration Date/Time: 2016-02-11 14,06.00 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-02-11 13:40:20
2013 Residential Compliance Schema Version: 2013.1.007
CERTIFICATE OF VERIFICATION CF3R-MCH-20-H
Duct Leakage Diagnostic Test (Page 2 of 3)
B. Duct Leakage Diagnostic Test
12 1 Notes:
C. Additional Requirements for Compliance
01
System was tested in its normal operation condition. No temporary taping allowed.
Outside air (OA) duct connections to the central forced air duct system shall not be sealed/taped off during duct leakage
testing. OA ducts used for Central Fan Integrated (CFI) Indoor Air Quality ventilation systems, or Central Fan Ventilation
02
Cooling Systems, that utilize dampers that open only when OA is required and automatically close when OA is not required,
may configure, the OA damper to the closed position during duct leakage testing,
03
If a complete replacement, all supply and return register boots were sealed to the drywall.
04
Building cavities were not used as plenums or platform returns in lieu of ducts.
05
If cloth backed tape;#as used it was covered with Mastic and draw bands.
06
All connection points between the air handier and the supply and return plenums are completely sealed.
t
If the system complies using the Smo e oke �Wkn ctej, in rclance w' nts
ml
be in le
'6 st t com s u(
43 s ke t sha I
of Reference Residential WX t 67
0,
3a ke
07
't
groups for HERS verifica#plianc
08
Verification Status
all applicA6 re4u"me s are met,
09
Correction Notes for this table
The responsible persons signature an this compliance document affirms that all applicable requirements In this table have
been met unless otherwise noted In the Verification Status and the Corrections Notes In this table.
D. Determination of HERS Verification Compliance
All applicable sections of this document shall indicate compliance With the specified verification protocol requirements in order
for this Certificate of Verification as a whole to be determined to be in compliance. I
1 01 1 Complies: Ali specified verification protocol requirements on this document are met. I
Registration Number: 215-A6328851A-M2000002A-M20A Registration Date/Time: 2016-02-11 14:06-00 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-02-11 13:40:20
2013 Residential Compliance Schema Version: 2013.1.007
CERTIFICATE OF VERIFICATION CF3R-MCH-20-H
Duct Leakage Diagnostic Test (Pap 3 of 3
i
Documentation Author's Declaration Statement
1. 1 certify that this Certificate of Verification documentation Is accurate and complete.
Documentation Author Name:
Documentation Author Signature.
tan Jacoby
Jan C)aco
Company:
Date Signed:
i PERMIT E RATERS
2016-02-11 13:41:04
Address:
CEA/ HERS Certification Identification (if applicable):
31225 La Baya Drive #213
City/State/Zip.
Phone:
West Lake Village CA 91362
818-735-7876
Responsible Person's Declaration statement
I certify the following under penalty of perjury, under the laws of the State of California:
1. The Information provicliad on this Certificate of Verification Is true and correct,
2. 1 am the certified HERS Ratgf.who performed the verification identified and reported on this Certificate of Verification (responsible rater).
3. The Instailled features, matedaK components, manufactured devices, or system performance diagnostic results that require HERS verification
Identifleilon this Certificate dfV6Ac*don comply with the applicable requirements In Reference Appendices RA2, RA3, and the requirements
specified otithe Certificate of Compliance for the building approved by the enforcement agency.
4. The informiriJloiireported on a e Certl (s) the I(s) responsible for the
construction or installation cv=pfimm to the u e e s L Pita approved e merit agency.
I
I " la with ilding it I_L
S. I will ensure that a registered of this C ificate of, Iss fi�" the
f this C Ic of
,�enforce #,at
building, and nriscle avallabo o.t. de and a py
with Ion the I r as but
Verification Is required to be u ng owner al
Builder Or Installer Information As Shown On'Th4 Iiieca"f instillation'
Company Name (installing Subcontractor, General Contractor, or Builder/Owner):
ESSER SERVICES INC
Responsible Builder or Installer Name-
SLB License:
T
Michael Esser
489046
HERS Provider Data Registry Information
Sample Group Number (if applicable):
Dwelling Test Status in Sample Group (if applicable)
Tested
HERS Rater Information
HERS Rater Company Name,
i PERMIT E RATERS
Responsible Rater Name:
Responsible Rater Signature:
Ryan Faris
Responsible Rater Certification Number w/ this HERS Provider
Date Signed:
CC2006345
2016-02-11 14:06:00
Do* signed by Calcam This digital signatme is provided in order to secure the oWent ofthis registered document and in noway implies Registralion Provider
nesponsitithty for the accuracy of the information.
Registration Number: 215-A6328851A-M2000002A-M20A Registration Date/Time: 2016-02-11 14:06M HERS Provider: CaICERTS
CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-02-11 13.40:20
2013 Residential Compliance Schema Version: 2013.1.007
CERTIFICATE OF VERIFICATION
CF3R-MCH-23-H
Space Conditioning System Airflow Rate
(Page 1 of 4 )
Project Name: PAT YANTIS
Enforcement Agency: City of
Palm Springs
Permit Number:
2015-3236
Dwelling Address: 71 WESTLAKE CIRCLE
City: Palm Springs
Zip Code:
92264
A. Ducted Cooling System Information
01
System Identification or Name
System 1
02
System Location or Area Served
Location 1
03
System installation Type
Alteration
04
Nominal Cooling Capacity (tons) of Condenser
5
05
Condenser Speed Type
Single Speed
06
1 Cooling System Zonattootred Type
Not Zonal
07 Central Fis Integrated (CFQ Ventilation System Status Not a CF I system
.. vim.
08 System Bypass Duct Status y u
09 Date of System rflow asure t 2 3F
10 Airflow Rate Protocol utilized �RA3.3atm s e t
S. Hole for the placement of a Static Pressure Probe (HSPP), and Permanently installed Static Pressure Probe (PSPP)
in the supply plenum.
Procedures for installing HSPP or PSPP are specified in RA3.3,1.1.
01 1 Method used to demonstrate compliance with the HSPP installed and labeled consistent with Figure RA33-1
HSPP/PSPP requirement
C. Airflow Rate Measurement Apparatus and Procedure Information
Instrument Specifications are giver, in RA3.3.1.1, and system airflow rate measurement apparatus information is given
in RA3.3.2.
Airflow Rate Measurement Type used for this airflow rate
Traditional Flow Capture Hood according to procedure in
01
verification.
RA3.3.11A
02
Manufacturer of Airflow Measurement Apparatus
ALNOR
03
Model number of Airflow Measurement Apparatus
EBT731
Certification Status of the Airflow Measurement Apparatus
Certified by Manufacturer and listed on CEC Website at
04
Accuracy
http://www.energy.ca.gov/title24/equipment_certjama_fas
/index.htmi
Registration Number: 215-A6328851A-M2300002A-M23A Registration Date/Time: 2016-02-11 14:06:00 HERS Provider: CaICERT.S
CA Building Energy/ Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-02-11 13:40:40
2013 Residential Compliance Schema version: 0.555SDD
CERTIFICATE OF VERIFICATION CF3RMCH-23-H
Space Conditioning System Airflow Rate (Page 2 of 4)
MCH-23a Forced Air System Airflow Rate Measurement - Newly Installed Non -Zoned Systems or Zoned Multi -Speed
Compressor
D. Forced Air System Airflow Rate Measurement
The procedures for System Airflow Rate Verification are specified in Reference Residential Appendix RA3.3.
01
Required Minimum System Airflow Rate (cfm/ton)
300
02
Required Minimum System Airflow Target (cfm)
1500
03
Actual System Airflow Rate Measurement (cfM)
1562
04
1 Compliance Statement:
System airflow rate complies
E. Additional Requirianwaft
Air filters that meefthe applicable requirements of Standards Section 150.0(m)12 or 150.0(m)13 were properly installed in
01
the systemduring system air flow rat , g-mia-asurement identified on this Certificate of Verification.
The airflow rate measuremeqapparattused he ai t ur n ified o h' figow
45
Verification was in calibrated ' orclanp, with man S i tons a' c9onfo s I
"
02
instrumentation specific 4ven in r
A visual inspection shall confirm'ihat bypass ducg;hat ' deliverconclitioned supply 111erectly to the space conditioning
system return duct airflow are not used on newly constructed zonally controlled systems unless the Performance Certificate
03
of Compliance indicates an allowance for use of a bypass duct. When a bypass duct is accounted for on the Performance
Certificate of Compliance, the airflow rate shall conform to the specifications listed on the Certificate of Compliance.
04
All registers were fully open during the diagnostic test.
05
System fan was set at maximum speed during the diagnostic test.
06
If fresh air duct is part of the HVAC system it was not closed during the diagnostic test.
07
Airflow rate and fan watt draw shall be simultaneous measurements when used to calculate the Fan Efficacy tested value.
Multi -speed compressor space cooling systems or variable speed compressor systems shall verify air flow (cfm/ton) and fan
08
efficacy (Watt/cfm) with system operating in cooling mode at the maximum compressor speed and the maximum air
handier fan speed.
09
Verification Status
I
Pass - all applicable requirements are met
10
Correction Notes
The responsible person's signature on this compliance document affirms that all applicable requirements in this table have
been met unless otherwise noted in the Verification Status and the Corrections Notes In this table.
Registration Number: 215-A6328851A-M2300002A-M23A Registration Date/Time: 2016-02-11 14,06M HERS Provider: CalCERTS
CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-02-11 13:40:40
2013 Residential Compliance Schema Version: 0.555SDD
Y
CERTIFICATE OF VERIFICATION CF3R-MCH-23-y
Space Conditioning System Airflow Rate (Page 3 of 4
F. Determination of HERS Verification Compliance
All applicable sections of this document shall indicate compliance with the specified verification protocol requirements in order
for this Certificate of Verification as a whole to be determined to be in compliance.
' 01 1 Complies: All specified verification protocol requirements on this document are met.
, - %�
APW
,i
ilk
1 E R KK
Registration Number: 215-A6328851A-M2300002A-M23A Registration Date/Time: 2016-02-11 14:06:00 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-02-11 13:40:40
2013 Residential Compliance Schema Version: 0.555SDD
CERTIFICATE OF VERIFICATION CF3R-MCH-23-H
Space Conditioning System Airflow Rate (Page 4 of 4 )
Documentation Author's Declaration Statement
1. 1 certify that this Certificate of Verification documentation Is accurate and complete.
Documentation Author Name:
Documentation Author Signature,
Ian Jacoby
a)rn x1co 6,-t
Company:
Date Signed-,
i PERMIT E RATERS
2016-02-1113:41:04
Address:
CEA/ HERS Certification Identification (if applicable):
31225 La Baya Drive #213
Clty/State/Zlp:
Phone:',
West Lake Village CA 91362
819-73S-7876
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 an this Certificate of Verification Is true and correct.
2. 1 am the certified HERS Rater performed the verification identified and reported on this Certificate of Verification (responsible rater).
3. The installed features, matei� components, manufactured devices, or system performance diagnostic results that require HERS verification
Weritifloic - n this Certificate criVerificatton comply with the applicable requirements in Reference Appendices RA2, RA3, and the requirements
specified`" Certificate of Compliance for the building approved by the enforcement agency.
4. The information reported an appk*hle re e the
construction or Installation conforms to the, uIr ncy.
ftcate
S. I will ensure th#4 registered of this of
building, and n, a avail enforce
Verification Is to with the of merrtatton
required
. ... ..........
Builder Or Installer Information As ihown On"Thoitilirtifitate bf InStillati4in"
Company Name (installing Subcontractor, General Contractor, or Builder/Owner):
ESSER SERVICES INC
Responsible Builder or Installer Name- CSLB License:
Michael Esser 489046
HERS Provider Data Registry Information
Sample Group Number (if applicable):
Dwelling Test Status in Sample Group (if applicable)
Tested
HERS Rater Information
HERS Rater Company Name-
i PERMIT E RATERS
Responsible Rater Name:
Responsible Rater Signature:
Ryan Faris
Responsible Rater Certification Number w/ this HERS Provider-
Date Signed:
CC2006345
2016-02-11 14:06:00
DVA*signed byCa10ERTs, This digital signature is provided in order to secure ft content of this registered document and in noway impkft Registration Provider
reqwabshty for the accuracy of the information,
Registration Number: 215-A6328851A-M2300002A-M23A Registration Date/Time: 2016-02-11 14M:00 HERS Provider: CaICERTS
CA 8uitding Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-02-11 13:40:40
2013 Residential Compliance Schema Version: 0.555SDD
I a,
CERTIFICATE OF VERIFICATION
CF3R-MCH-2S-H
Refrigerant Charge Verification
(Page I of 4 )
Project Name: PAT YANTIS
Enforcement Agency. City of
Palm Springs
Permit Number.
2015-3236
Dwelling Address: 71 WESTLAKE CIRCLE
City: Palm Springs
Zip Code:
92264
A. System Information
HERS Rater to field -verify all system Information, discrepancies to be noted by overwriting entry.
01
System Identification or Name
System 1
02
System Location or Area Served
Location 1
03
Condenser (or package unit) make or brand
TRANE
04
Condenser (or package unit) model number
4TTV8060AI000AA
05
Nominal Cooling Capacity (tons) of Condenser
5
06
Condenser (or package unit) serial number
14421P5JIF
07
Refrigerant Type
08
Other Refrigerant Type Of !P*able)
az
09
-Now* -now
System Installaii0n Type t 40
W,
teration
Charge Indicator Display (CID) Status (Note: Even systems
This system does not have a CID device install
10
with a CID must have refrigerant charge verified by installer).
is the system of a type that the minimum airflow can be
Yes, this is a ducted system and one of the system airflow
11
verified using an approved measurement procedure (RAU
rate measurement procedures in RAU or RA3.2.2.7 can be
or RA3.2.2.7)?
used to verily system airflow rate requirements.
Is the system of a type that approved refrigerant charge
Yes, one of the Refrigerant charge verification procedures
verification procedures can be used to verify compliance
from RA3.2.2 or RAI is applicable to this system and can be
12
with the refrigerant charge verification requirements when
used to verify compliance
temperatures are greater than or equal to 55F (RA3.2.2, or
RAI)?
13
Date of Refrigerant Charge Verification for this system
2016-02-04
Refrigerant charge verification method used.
Subcooling (outdoor temperature must be equal to or
14
greater than 55 degF)
15
Person who performed the Refrigerant Charge Verification
HERS rater
reported on this Certificate of Installation
16
HERS Verification Compliance Requirement Status
System does not qualify for group sampling
17
Refrigerant charge verification method used by HERS Rater.
Subcool
Registration Number: 215-A6328851A-M2500002A-M25A Registration Date/Time: 2016-02-11 14:06:00 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-02-11 13.41:06
2013 Residential Compliance Schema Version: 2013.1.007
CERTIFICATE OF VERIFICATION CF3R-MCH-25-H
Refrigerant Charge Verification (Page 2 of 4)
I MCH25b - Refrigerant Charge Verification - Subcooling Method I
B. Metering Device Verification - HERS Rater Is required to visually field verify all Information from CF2R
Subcooling Method can only be used on systems that have a variable metering device.
01
Refrigerant metering device
Thermostatic Expansion Valve (TXV)
02
Subcooling Method applicability status
Subcooling Method is applicable to this system.
C. Instrument Calibration - HERS Raters are required to calibrate their diagnostic tools.
Procedures for instrument calibration are given in Reference Residential Appendix RA3.2.2 and RA3.2.2.2
01
Date of Digital Refrigerant Gauge Calibration
2016-02-01
02
Date of Digital Thermocouple Calibration
2016-02-01
03
Digital R, ~,aft4auge tal%Mion Status
Calibration is current
04
Digital Thermobduple CalibratO
D. Measurement Aams Holt
Procedures for installing MAH
ol IMethod used to demonstrate compliance with the MAH installed and labeled consistent with Figure 3.2-1
Measurement Access Hole (MAH) requirement I I
E. Minimum System Airflow Rate Verification
Procedures for verifying minimum system airflow are specified in Reference Residential Appendix RA3.2.2.7.
01
Minimum Required System Airflow Rate (cfm)
1500
02
System Airflow Rate Verification Status
System complies with minimum airflow rate requirements
F. Data Collection - HERS Rater must independently collect all data in this section.
Procedures for determining Refrigerant Charge using the Standard Charge Verification Procedure are given in
Reference Residential Appendix RA3.2.2 and RA3.2.2.2
01
Lowest return air dry bulb temperature that occurred during
70
the refrigerant charge verification procedure (degreeF)
02
Measured Condenser air entering dry-bulb temperature (T
60
condenser, db)
03
Outdoor Temperature Qualification Status
I
Outdoor temperature is within range for using Subcooling
refrigerant charge verification method
Registration Number: 215-A6328851A-M2500002A-M25A Registration Date/Time: 2016-02-11 14,06M HERS Provider: CaICERTS
CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-02-11 13:41:06
2013 Residential Compliance Schema Version: 2013.1.007
CERTIFICATE OF VERIFICATION CF3R-1MCH-25-H
Refrigerant Charge Verification (Page 3 of 4)
F. Data Collection - HERS Rater must Independently collect all data In this section.
Procedures for determining Refrigerant Charge using the Standard Charge Verification Procedure are given in
Reference Residential Appendix RA3.2.2 and RA3.2.2.2
04
Measured Liquid Line Temperature (TNuid) (degreel')
65
05
Measured Liquid Line Pressure (Piiquw) (pisg)
221
06
Condenser saturation temperature (Tcandensor, sat) from digital
78
gauge or P-T Table using Line F05 (degree F)
07
Measured Subcooling
13
08
Target Subcooling 10
Compliance Statement.I System complies with Subcooling Method - Must also pass metering device verification, next
09
I
section
G. Metering Device VerfflcaUor#
Procedures for the verification of privorMitering device operation are specified in RA3.2.2.6.2
'Aoft 9 AWWL-' vm-' 0-W, MWAPS AOMO Wl
01 Measured Suction line ternPLure (d "Q F
r
02 Measured Suction line pres pwctoa)
X M F97%wm'
03 Evaporator saturation temperature (Teva satfvbm 41
digital gauge or P-T Table using line G02 (degreel')
04 Measured Superheat 19
05 Measured Superheat is between 3 and 26 deg F (inclusive) Passes CEC requirement
06 Measured Superheat is within manufacturer's specifications, Not known
tif
known 1
Compliance Statement: Metering device verification passes
H. Determination of HERS Verification Compliance
All applicable sections of this document shall indicate compliance with the specified verification protocol requirements in order
for this Certificate of Verification as a whole to be determined to be in compliance. I
1 01 1 Complies: All specified verification protocol requirements on this document are met. I
Registration Number: 215-A6328851A-M2500002A-M25A Registration Date/Time: 2016-02-11 14M:00 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-02-11 13:41:06
2013 Residential Compliance Schema Version: 2013.1.007
CERTIFICATE OF VERIFICATION CF311-MCH-25-1-1
Refrigerant Charge Verification (Page 4 of 4
Documentation Author's Declaration Statement
1. 1 certify that this Certificate of Verification documentation Is accurate and complete.
Documentation Author Name.
Ian Jacoby
Documentation Author Signature:
:Xan
Company:
Date Signed,
i PERMIT E RATERS
2016-02-11 13:41:04
Address:
CEA/ HERS Certification Identification (if applicable):
31225 La Baya Drive #213
city/state/zip;
Phone;
West Lake Village CA 91362
818-735-7876
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 an this Certificate of verification is true and correct.
2. 1 am the certifik HERS Rater who performed the verification identified and reported on this Certificate of Verification (responsible rater),
3. The installed fe�tur ,'matirfals, components, manufactured devices, or system performance diagnostic results that require HERS verification
Identifiedon this Cerdfimte oll'Verification comply with the appikable requirements in Reference Appendices RA2, RA3, and the requirements
specified oiCertificate of Compliance for the building approved by the enforcement agency.
4. The InformatWr"orted on pplicable ecti 4*e Certl ks) bi by the pefVn(s) responsible for the
construction or Installation 4=s to thethe Ce la approved ego1owmar'"14P
pl ncy.
PI
S. I will ensure that a regime!If this C R be ad, Ith Ith ilding permit( o Issued f& the
, and nuide wall
buildingd n d
be
Verification Is req6i'red to with t.1theow-Eftlon b rpr es o b I g owner a &-cu
Builder Or Installer Information As Shown bn-Th ri*c Insti"on t
'li'
Company Name (installing Subcontractor, General Contractor, or Builder/Owner):
ESSER SERVICES INC
Responsible Builder or Installer Name:
CSLB License:
Michael Esser
489046
HERS Provider Data Registry Information
Sample Group Number (if applicable):
Dwelling Test Status in Sample Group (if applicable)
Tested
HERS Rater Information
HERS Rater Company Name:
i PERMIT E RATERS
Responsible Rater Name.
Responsible Rater Signature:
Ryan Faris
Responsible Rater Certification Number w/ this HERS Provider-
Date Signed:
CC2006345
2016-02-11 14:06:00
&91ta#YsigwdhyCa10EM Ttus cWaf smnatme is provided in order to secure the content of than reVstered document mid in noway imphesqegistration Provider
responsibih ty for the accuracy of the in fomwhw.
Registration Number: 215-A6328851A-M2500002A-M25A Registration Date/Time: 2016-02-11 14:06:00 HERS Provider: CaICERTS
CA Building Energy Efficiency Standards Report Version: 2013 Rev 1.007 Report Generated: 2016-02-11 13-.41:06
2013 Residential Compliance Schema Version: 2013.1.007
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