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Prescriptive Certificate of Compliance:CIr-1R ADD <br />Residential Additions (Page 5 of 5) <br />Site Address· e • Enforcement Agency:Da-1 3 11 NA k, Ati-, A- <br />HERS VERIFICATION SUMMARY - The enforcement agency should pay special attention to the HERS Measures specified in this <br />checklist below. A completed and signed CF-4R Form for all the measures specified shall be submitted to the building inspector before final <br />inspection. <br />Duet Seding & Uesting HERS verification is required for this measure. <br />O YES )) In all Climate Zones, if a new space-conditioning system (HVAC equipment and ducting) is installed to serve the additionalone, the ducts are to be sealed and tested per §151(f)10. <br />In Climate Zones 2 and 9-16, if more than 40 linear feet of new or replacement ducts are installed in unconditioned <br />O YES <O space to serve the addition, the ducts are to be sealed and tested per §152(b)ID. O EXCEPTION: Existing duet systemsthat are extended, which are constructed, insulated or sealed with asbestos. <br />In Climate Zones 2 and 9-16, if the existing HVAC equipment is replaced (including replacement ofthe air handler, outdoor <br />condensing unit of a split system, cooling or heating coil, or the furnace heat exchanger) and will serve the addition, the ducts <br />are to be sealed and tested per §152(b) lE. <br />¤ YES <NO O EXCEPTION: Duct systems that are documented to have been previously sealed confirmed through HERSverification in accordance with procedures in the Reference Residential Appendix RA3. <br />I EXCEPTION: Duet systems with less than 40 linear feet in unconditioned space. <br />O EXCEPTION: Existing duet systems constructed, insulated or sealed with asbestos. <br />Refrigerant Charge - Split System HERS ver(#cation is requiredfbr this measure. <br />O YES a charge measurement shall be verified per §151(07A.a NO In Climate Zones 2 and 8-15, i f a newly ducted split A/C or heat pump is installed to serve the addition alone, a refrigerant <br />In Climate Zones 2 and 8-15, if the existing HVAC equipment is replaced (including replacement of the air handler, outdoor <br />O YES BNO condensing unit of a split system, cooling or heating coil, or the furnace heat exchanger) and will serve the addition, a <br />refrigerant charge measurement shall be verified per § 1 52(b)1 F. <br />Central Fan Integrated Ventilation System - Airllow and Fan Watt Draw - do not apply for additions 1,000 ff or less. <br />Ducted Split Systems - Air Conditioners and Heat Pumps: Airllow and Fan Watt Draw HERS verification is required. <br />In Climate Zones 10 through 15, i f a new space-conditioning system (HVAC equipment and ducting) is installed to serve theO YES [*40 addition alone, the airflow and fan watt draw shall be verified per §151(f)7B. <br />In Climate Zones 10 through 15, if the existing space-conditioning system (HVAC equipment and ducting) is replaced andO YES ONO <br />Will serve the addition, the airflow and fan watt draw shall be verified per §152(b)IF. <br />Documentation Author's Declaration Statement <br />• I certify that this Certificate of Compliance documentatiom .to an 4 complete. <br />Name:Signal'aRAG(o G. 6(-AtA 4-I <br />CompaCASS t*-srd f ' - ]13 <br />Adiff 9 l k-1 4460 +Le-orL (Lertification #) <br />CEA or O CEPE <br />C*347(64<*4 8€*c*, Ch ?21¥K ?in, 901-423 <br />Responsible Building Designer's Declaration Statement <br />• I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the building design identified on <br />this Certificate of Compliance. <br />• I certi fy that the energy features and performance specifications for the building design identified on this Certificate of Compliance conform <br />to the requirements of Title 24, Parts 1 and 6 ofthe California Code of Regulations. <br />• The building design features identified on this Certificate of Compliance are consistent with the information provided to document this <br />building design on the other applicable compliance forms, worksheets, calculations, plans and specifications submitted to the enforcement <br />agency for approval with this building permit application. <br />Name:Signature: <br />-gl <br />./. <br />.. <br />Company:Date: <br />Address:License: <br />City/State/Zip:Phone: <br />For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300. <br />Registration Number: <br />2008 Residential Compliance Forms <br />Registration Date/Time:HERS Provider: <br />March 2010 <br />S accu <br />e: <br />Date: / <br />If Applitable [