13-0182 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 13-00000182
Property Address: 54835 RIVIERA
APN: 775-031-003- -
Application description: MECHANICAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 14000
Applicant: Architect or Engineer:
------------------
LICENSED CONTRACTOR'S DECLARATION
S %
BUILDING & SAFETY DEPARTMENT.
BUILDING PERMIT
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 Business and Professionals'Code, and my License is in full force and effect.
License Class: C20 License No.: 686310
Date: zZ-0�� Contractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
following reason (Sec. 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 -
pormit to file a sioned statement that he or she is licensed pursuant to the provisions of the Contractor's State
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professluus 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).:
(_) 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, Business and Professions Code: -The
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
and who does the work himself or herself through his or tier own employees, 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 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.
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 contractor(s) licensed
pursuant to the Contractors' State License Law.).
1 _ 1 I am exempt under Sec. BAP.C. for this reason
Date: Owner:
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:
LQPERMIT
Owner:
BEN MOXON
54835 RIVIERA
LA QUINTA, CA
(
DRIVE
92252
Contractor:
GENERAL AIR CONDITI
31170 RESERVE DRIVE
THOUSAND PALMS, CA
(760)343-7488
Lic. No.: 686310
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/20/13
r
WORKER'S COMPENSATION DECLARATION
hereby affirm under penalty of perjury one of the following declarations:
_ I have and will maintain a certificate of consent to self-insurefor workers' 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
j insurance carrier and policy number are:
Carrier ZENITH INS CO Policy Number Z071741502
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 workers' compensation laws of California,
and agree that, if 1 should become subject to the workers' compensation provisions of Section
.1700 of the Labor Code, I shall forthwith comply with those provisions.
Date:' aO 13 (A p scant: r r
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
conditions and restrictions set forth on this application.
1 . Each person upon whose behalf this application is made, each person at whose request and for
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quinta, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work is not commenced
within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject
permit to cancellation. -
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. r
Date: • ZJ 20 11. Signature (Applicant or Agent): c—
G'
Application Number . . . . . 13-00000182
Permit . . . MECHANICAL
Additional desc .
Permit Fee . . . . 40.50 Plan Check Fee'.
10.13
Issue Date . . . . Valuation . . . .
0
Expiration Date 8/19/13
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 9.0000 EA MECH FURNACE <=100K
9.00
1.00 16.5000'EA MECH B/C >3-15HP/>100K-500KBTU
16.50
----------------------------------------------------------------------------
Special Notes and'Comments
3 TON PACKAGE UNIT, INCLUDES FURNACE AND
A/C. 2010 CALIFORNIA BUILDING CODES..
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (8B1473)
1.00
Fee summary Charged Paid Credited
---------- ---------- ---------- ----------
Due
-----------------
Permit Fee Total 40.50 .00 .00
40.50
Plan Check Total 10.13 00 .00
10.13
Other Fee Total 1.00 .00 .00
1.00
Grand Total 51.63 .00 .00
51.63
LQPERMIT
Bin,#
'
Clty Of u QuIC%La
Building 8t Safety Division
P.O. Box 1504,78-495 Calle Tampico
La.Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
ProjectAddress: -S(4 Fs 3 -!��v .e ( A �� .
Owner's Name:.
A. P. Number.
Address: ��}$?jS i�; V ev C fir•
Legal Description: \
Contractor. e.� 0.1 A� ,- ��i
City, ST, Zip: L a (�vir a CA q Z2S�
Telephone:
\�q�
Address: 3 )o
j(
Project Description: Rs ttUce 3`�0
City, ST, Zip:
Telephone: —A-0- 3'•13. 74 88
C_
State Lic. # : City Lic; #,
Arch, Engn, Designer.
Address:
City., ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:
Construction Type:. Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft: #Stories: # Units:
Telephone # of Contact Person:
Estimated Value of Project 000
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Req'd
Recd
TRACMG
PERMUFEES
Plan Sets
Plan Check submitted
item Amount
Structural Calm
Revlewed, ready for corrections
Plan Check Deposit. .
Truss Calcs.
Called COUtaet Person
Plan Check Balance.
Title 24 Cities.
Plaits picked up
Construction
Flood plain plan
Plans resubmitted
Mecharilcal
Grading plan
2'! Review, ready for correctionstiissue
Electrical
Subeoutactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
ML
L
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE-.-
''d Review; ready for eorrecdomfissae
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVACAlterations CF-lR-ALT-HVAC
Climate Zones 10 - 15
Site Address:
Enforcement Agency:
Date:
Permit #:
54835 RIVIERA DRIVE La Quinta, CA 92253
City of La Quinta
Feb 20, 2013
Equipment Typel
List Minimum Efficiency2
Duct insulation
requirement
Conditioned Floor
Area
Thermostat
0 Package Unit
0 Furnace
0 Indoor Coil
® AFUE 8%
® SEER 13.0
O COP
0 HSPF
0 R 6 (CZ 10-13)
Served by system
0 Setback
If not already present, must be
p Condensing Unit
[3 EER
0 Resistance
0 R 8 (CZ 14-15)
installed)
0 Other
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF-lR-ALT-HVAC for each system.
2. Minimum Equipment Efficiencies: 13 SEER, 78% AFUE, 7.7HSPF for typical residential systems.
HERS VERIFICATION SUMMARY Listed below are FOUR HVAC alteration Options. The installer decides what work is being done
and picks one of the appropriate Options. Each Option lists the HERS measures that must be conducted. A copy of the forms shall
be left on site for final inspection and a copy given to the homeowner. At final, the inspector verifies that the work listed on this
form was in fact the work completed by the installer. The inspector also verifies that each appropriate CF -6R and registered CF -411
forms (no hand filled CF-4Rs allowed) are filled out and signed.Beginning October 1, 2010, a registered copy of the CF -111
and CF -611 shall also be on site for final inspection.
® 1. HVAC Changeout
Required Forms:
. All HVAC Equipment
CF -611 forms: MECH-04, MECH-21-HERS ,stems) 114EGH .16 WERS
replaced
CF -411 forms: MECH-21 and (fGF Split systems) ME. -N_2
. Condenser Coil and /or
. Indoor Coil and /or
CF -6R forms: MECH-04, MECH-2I-HERS
. Furnace
CF -411 forms: MECH-21 BRa r(.... split systems) NEG14 -L
Fer. Split Systems, Duet-. jea1w --repi:i% RG, r.GA Lr d109 GF-N,49R (Pilinimu-FRAW W9W ReGIUiFeFReRQ, T -NAW
For Packaged Units: Duct leakage.:.< 15 percent
Exempted from duct leakage testirig;;if::.
❑ i:.DucC systerai bias documeEittd to have been previously sealed and confirmed through HERS verification, or
•'0 2; Duct systems with less th":`40 linear feet in unconditioned space, or
0.:3. Existing duct systems are ieoristructed, insulated or sealed with asbestos
0 4.:Th s' " :ill not be Duct. (ie " cEf i�4i<: 'pl."yste►ta. b xern fi "Ief` erg r e
0 2 Ne Re urceth:.;<<--::: s;;'c -
fi)C em 4 Fri :ms:?'='i:`c; ;_ ":.::;
. Cut iri ._ ."'angeout wi
fi1E.CH-04 M-2t9r.HERS r ar lit
new f. MEC
ductr,; .
......:::<:::::<:� -
-.;fio MECH D :f r. i
equipm -: �. �.:.. ,.o spt.:,, '#tt . • - Gif;2-- <M>vi=:z,?'_
Farsp SySettiist.c:i3... >leafiCa e;c.<: "e%.:._._: _°=C.",.; 5:34Ci"�h/ko�tt:?F11dDtNFA1i`"l1S an'if`rttHer tiSPP or PSPP.
bt;.g....--;...::�`.::.>:._:::....;:::.:....:....:.:.:._......::.- .::::.:..>..:....... .
...............
For Packaged Units: i,ct leakage-<..:fpr;rcerit`.'::
C7:3.:PIew,D;uct =Virith/or without' -
Required Forms:
Replaerriefiii ::: `•::`.`"` `.:::: .. .
. Includes replacing or iristalling alt fiew
ducting and/or outdoor'cohdensirtj;Unit
CF -6R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS
and/or indoor coil and/or fiirry:at.6No or some
CF -411 forms: MECH-20 and (for split systems) MECH-25
equipment changed.
For Split Systems: Duct leakage < 6 percent; RC, CCA z 300 CFM/ton, TMAH
For Packaged Units: Duct leakage < 6 percent
0 4. New Ducting over 40 feet
Required. Forms:
. Includes adding or replacing more than 40
CF -611 forms: MECH-04, MECH-2I-HERS
linear feet of duct in unconditioned space.
CF -411 forms: MECH-21
For split system or packaged units: Dud leakage < 15 percent
0 EXCEPTION: Existing dud systems constructed, insulated or sealed with asbestos.
Contractor (Documentation Author's /Responsible Designer's Declaration Statement)
. I certify that this Certificate of Compliance documentation is accurate and complete.
. I am eligible under.Division 3 of the California Business and Professions Code to accept responsibility for the design Identified on this Certificate of
Compliance.
. I certify 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 Callfomla Code of Regulations.
. The design features Identified on this Certificate of Compliance are consistent with the Information documented on other applicable compliance
forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with the permit application.
Name: Danielle Garcia Signature: Danielle Garcia
Company: HARRISON ENTERPRISES INC Date: Feb 20, 2013
Address: 31-170 RESERVE DRIVE STE A License: 686310
City/State/Zip: THOUSAND PALMS / CA / 92276 Phone: (760) 343-7488
Reg: 213-AO01072OA-000000000-0000 Registration Date/Time: 2013/02/20 02:45:57 HERS Provider: CalCERTS, Inc_
`2008 Residential Compliance Forms July 2010
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-21
Duct Leakage Test — Existing Duct System (Page 1 of 2)
Site Address:
54835 RIVIERA DRIVE, La Quinta CA 92253 (System
Enforcement Agency:
Permit Number:
1)
City of La Quinta
13-182
Enter the Duct System Name or Identification/Tag: System 1
Enter the Duct System Location or Area Served: Whole House
Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the
dwelling.
This installation certificate is required for compliance for alterations and additions in existing dwellings to
space conditioning systems and duct systems.
Note: For existing dwellings, a completely new or replacement duct system can also include existing parts of
the original duct system (e.g., register boots, air handler, coil, plenums, etc.) if those parts are accessible
and they can be sealed. For a completely new or replacement duct system installed in an existing dwelling,
use the Installation Certificate titled 'Duct Leakage Test - Completely New or Replacement Duct System. "
Duct Leakaqe Diagnostic Test - existino duct system
Select one compliance method from the following four choices.
❑ 1. Measured leakage less than 15% of fan flow
❑ 2. Measured leakage to outside less than 10% of Fan Flow
❑ 3. Reduce leakage by 60% and conduct smoke and fix all leaks
❑ 4...Fix all accessible leaks using smoke and HERS rater verify.
Note: (One of Options 1, 2, or 3 must be attempted befor,e,utiliz.ing Option,4,),,,
Determine norriinal'Fan Flow using one offthe following three calculation.methods t
✓ ❑ Coolin s stem method Size of�condenser in Tons_ x 400 _ ,CFM
9 Y.:
z
}.
✓ ❑ Heating z
system method 21 7 Output Capacity in.Thousands of.Btu/hr
-'13 Me'sured system a rtlow using%_RA3 3 airflowesY CFM.=
procedures:
Optionl,used.thena ,
Allowed,
1
leakage = Fan Flow x 0.15 = _ CFM
Actual.Leakage7=_ CFM
Pass if Leakage Actual is less than Allowed
❑ Pass Fail
Option 2 used then:'
2
Allowed leakage = Fan Flow_ x 0.10 = _ CFM
Actual Leakage to outside = ` CFM
Pass if Leakage Actual is less than Allowed
❑ Pass ❑ Fail
Option 3 used then:
Initial leakage prior to start of work = _ CFM
Final leakage after sealing all accessible leaks using smoke test = CFM
3
Initial leakage _ - Final leakage _ = Leakage reduction _ CFM
((Leakage reduction _/ Initial leakage x 100% _ % Reduction
Pass if % Reduction >= 60%
Pass Fail
Option 4 used then:
4
All accessible leaks repaired using smoke test. HERS rater must verify (No sampling).
Pass if all accessible leaks have been repaired using smoke
0 Pass Fail
3
ct
Reg: 213-A0010720A-M2100001A-M21A Registration Date/Time: 2013/04/13 16:34:29 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-21
Duct Leakage Test — Existing Duct System (Page 2 of 2)
Site Address:
54835 RIVIERA DRIVE, La Quinta CA 92253 (System
Enforcement Agency:
Permit Number:
1)
City of La Quinta
13-182
❑ Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off
during'duct leakage testing. CFIOA ducts that utilize controlled motorized dampers, that open only when OA
ventilationisrequired to meet ASHRAE Standard 62.2, and close when OA ventilation is not required, may
be configured to the closed position during duct leakage testing.
x�L �. *
❑ All supply and return registeryboots must 66Vdaled to the drywalkaf�srnoke test is utilized fopcgmpliance
applies to duct leakage compliance option 3 (leakage reduction y-60%) and option 44(fx all accessible
leaks) described above, Irr
❑ New duct Installations cahno*tyiputiliib building caviiii+es as?plenums o'rDplatform�returns in -lieu of ducts, ,
x>aTE:Fr �i Cs �w�6 wA: `' :'w- .k 3 �pzay;�. �Y ..
❑ Mastic and:.draw bands musk`be used,m.cornbinatioh with cloth`backed'rubber'adhesive duct pe to seal
leaks at all new duct connections
DECLARATION STATEMENT,*"
• I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct.
• I am the certified HERS rater Ao;performed the verification services identified and reported on this certificate (responsible rater).
• The installed feature, material, component, or manufactured device requiring HERS verification that is identified on this certificate (the
installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified
on the Certificate(s) of Compliance (CF -111) approved by the local enforcement agency.
• The information reported on applicable sections of the Installation Certificate(s) (CF -611), signed and submitted by the person(s)
responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -SR) approved by the
enforcement agencv.
Builder or Installer information as shown on the Installation Certificate (CF -6R)
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
HARRISON ENTERPRISES INC
Responsible Person's Name:
License: .
Danielle Garcia -
1CSLB
686310
HERS Provider Data Registry Information
Sample Group # (if applicable): 399765
❑ tested/verified dwelling
®not-tested/verified dwelling in
la
HERS sample group
HERS Rater Information . CalCERTS Certificate # CCi-1798733198
HERS Rater Company Name:
Stratz Permit Service
Responsible Rater's Name:
Responsible Rater's Signature:
Garrett Williams
Garrett Williams
Responsible Rater's Certification Number w/ this HERS Provider:
Date Signed: 4/9/2013
CC2006208
Reg: 213-A0010720A-M2100001A-M21A Registration Date/Time: 2013/04/13 16:34:29 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
r
INSTALLATION CERTIFICATE CF-611-MECH-2I-HERS
Duct Leakage Test — Existing Duct System (Page 1 of 2)
Site Address:
54835 RIVIERA DRIVE, La Quinta CA 92253 (System
Enforcement Agency:
Permit Number:
City of La Quinta
13-388
Enter the Duct System Name or Identification/Tag: System 1
Enter the Duct System Location or Area Served: Whole House
Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the
dwelling. -
This installation certificate is required for compliance for alterations and additions in existing dwellings to
space conditioning systems and duct systems.
Note: For existing dwellings, a completely new or replacement duct system can also include existing parts of
the original duct system (e.g., register boots, air handler, coil, plenums, etc.) if those parts are accessible
and they can be sealed. Fo? a completely new or replacement duct system installed in an existing dwelling,
use the Installation Certificate titled "Duct Leakage Test - Completely New or Replacement Duct System. "
Duct Leakage Diagnostic Test - existing duct system
Select one compliance method from the following four choices.
® 1. Measured leakage less than 15% of fan flow
❑ 2. Measured leakage to outside'iess than 10% of Fan Flow
❑ 3. Reduce leakage by 60% and.conduct smoke and fix all leaks
❑ 4: Fix all accessible leaks using smoke and HERS rater verify
Note: (One of Options 1, 2 or 3 must lie,attemptegj"fq utilizing,Option 4;) g y_
DetermineAnominal''Fan Flow using'one o f-tKe following three calculationrtmethods
✓ ®Cooling syrstom method Sae of condenser in Tons `3x 400'`= 12p0 CFM s? a
c +e' r, x
✓ ❑ Heatmg,system
method: -121'7 x� rOtitput Capacity+in.Thousands of Btu/hr - CFM * r t
�yN —
w'"' �
✓ ❑ Measured s tem airFlow usm €RA3 3 airflow test rocedures:
y&. , 9. P
'-1200Y ,x
f.,s.s. -:
1
Allowed leakage -`Fan Airflow 0:15 180 CFM
Actual Leakage = 96 CFM
� ,-� ;' Pass if Actual Leakage is less than Allowed leakage
®Pass Fail
Option 2 used then:-.
2
Allowed leakage = Fan*Airflow- x 0.10 = _ CFM
Actual Leakage to outside's It, CFM
` -Pass if Actual leakage to outside is less than Allowed leakage
❑ Pass Fail
Option 3 used then:
Initial leakage prior to start of work = _ CFM
Final leakage after sealing all accessible leaks using smoke test=CFM
3
Initial leakage _ - Final leakage _ = Leakage reduction _ CFM
((Leakage reduction—/ Initial leakage x 100% _ % Reduction
Pass if % Reduction >= 60%
Pass Fail
Option 4 used then:
4
All accessible leaks repaired using smoke test. HERS rater must verify (No Sampling).
Pass if all accessible leaks have been repaired using smoke
Pass Fail
R
Reg: 213-A0019429A-M2100001A-0000 Registration Date/Time: 2013/04/13 16:14:39 HERS,Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS
Duct Leakage Test - Existing Duct System (Page 2 of 2)
Site Address:
54835 RIVIERA DRIVE, La Quinta CA 92253 (System
Enforcement Agency:
Permit Number:
1)
City of La Quinta
13-388
® Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off
during duct leakage .testing. CFI OA ducts that utilize controlled motorized dampers, that open only when OA
ventilation is required to meet ASHRAE Standard 62.2, and close when OA ventilation is not required, may
be configured to the closed position during duct leakage testing.
® All supgly�and return registerboots-rnustbeseaed to,thedrywall-if smoke testis utilized forcompliance
- applies to duct leakage compliance option 3 (leakage reduction by6061b and option 4 (fix all accessible
leaks) described abo
® New ductinstailatlonsrcannot:utillze building cavities asjplenumspor,platfo,rm returns i lieu of ducts ,.
® Mastic and draw bands'mustb`e used Pin comb.i.nation with cloth.backed rubber adhesive'duct'tape t seal
leaks at all new duct connections
DECLARATION STATEMENT
• I certify under penalty of perjyry, underthe laws of the State of California, the information provided on this form is true and correct.
• I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized
representative of the person responsible for construction (responsible person).
• I certify that the installed features, materials, components, or manufactured devices identified on this certificate (the installation)
conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the
enforcement agency.
• I 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 -111) 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 Certificate shall be posted, or made available with the
building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I
understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder
provides to the building owner at occupancy. I will ensure that all Installation Certificates will come from a HERS provider data
registry for multiple orientation altematives, and beginning October 1, 2010, for all low-rise residential buildings.
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
HARRISON ENTERPRISES INC
Responsible Person's Name:
Responsible Person's Signature:
Danielle Garcia
Danielle Garcia
CSLB License:
686310
Date Signed:
4/1/2013
Position With Company (Title):
Is this installation monitored by a Third Party Quality
Name of TPQCP (if applicable):
Control Program (TPQCP)? ❑ Yes ❑ No
Reg:.213-A0019429A-M2100001A-0000 Registration Date/Time: 2013/04/13 16:14:39 HERS Provider: CalCERTS, inc.
2008 Residential Compliance Forms March 2010
ti.
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-21
Duct Leakage Test - Existing Duct System (Page 1 of 2)
Site Address:
54835 RIVIERA DRIVE, La Quinta CA 92253 (System
Enforcement Agency:
Permit Number:
1)
City of La Quinta
13-388
Enter the Duct System Name or Identification/Tag: System 1 7-
En—ter
Enter the Duct System Location or Area Served: Whole House
Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the
dwelling.
This installation certificate is required for compliance for alterations and additions in existing dwellings to
space conditioning systems and duct systems.
Note: For existing dwellings, a completely new or replacement duct system can also include existing parts of
the original duct system (e.g., register boots, air handler, coil, plenums, etc.) if those parts are accessible
and they can be'sealed. For a completely new or replacement duct system installed in an existing dwelling,
use the Installation Certificate titled "Duct Leakage Test - Completely New or Replacement Duct System. "
Dud Leakage Diagnostic Test - existing duct system
Select one compliance method from the following four choices.
❑ 1. Measured leakage less than 15% of fan flow
❑ 2. Measured leakage to outside less than 10% of Fan Flow
❑ 3. Reduce leakage by 60% and conduct smoke and fix all leaks
❑ 4. -,Fix all 'accessible leaks using smoke and HERS rater verify
Note (One of Optibns.l,_2, or 3 mustbe-attempted;pefore,.utilizing Option;4..)
Determine rib minal`fan Flow using one;oaf�the following three calculation methods
✓ ❑ Cooling,system method Sze of condenser in Tons x 400 CFM
✓ AW
❑ Heating system method X21 71X Output Capacityin,Thousands of Btu/hr - _ CFM yw'"
✓ ❑ Meas,fCFM: Y
Option l used then -: a3x�,r
1 .
Allowed leakage Fan Flow x 0.15 _CFM'
Actual.,Leak6
9 a CFM
Pass if Leakage Actual is less than Allowed
❑ Pass ❑ Fail
Option 2 used then
0-
2
Allowed leakage = Fan'Flow x 0.10 = _ CFM_
ActualLeakage to outside._ -CFM
F
.. Pass if Leakage Actual is less than Allowed
i] Pass ❑ Fail
Option 3 used then:
Initial leakage prior to start of work = _ CFM
Final leakage after sealing all accessible leaks using smoke test = _ CFM
3
Initial leakage _ - Final leakage _ = Leakage reductionCFM
((Leakage reduction_/ Initial leakages x 100% _ %Reduction
Pass if % Reduction >= 60%
Pass Fail
Option 4 used then:
4
All accessible leaks repaired using smoke test. HERS rater must verify (No sampling).
Pass if all accessible leaks have been repaired using smoke
Pass Fail
Reg: 213-A0019429A-M2100001A-M21A Registration Date/Time: 2013/04/13 16:34:29 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-21
Duct Leakage Test - Existing Duct System (Page 2 of 2)
Site Address:
54835 RIVIERA DRIVE, La Quinta CA 92253 (System
Enforcement Agency:
Permit Number:
1)
City of La Quinta
13-388
❑ Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off
during duct leakage testing. CFI'OA ducts that utilize controlled motorized dampers, that open only when OA
ventilation is required to meet ASHRAE Standard 62.2, and close when OA ventilation is not required, may
be configured to the closed position during duct leakage testing.
.'
❑ All supplyianrd return register boots roust bei sealed >to the drywall, if smoke test is utilized foreompliance
- applies'to duct leakage compliance option 3 (leakage reduction b 60%) :and option 41(fix all accessible
leaks descntied abov01,
Ve
❑ New duct installations cannot utilize buildirl. cavities aslplenurns or platform returns n lieu -of ducts-5�X
"?.'
❑ Mastic an draw bands' must`be used'm'co.n bination with' cloth backed rubber adhesive'duc? pe to seal
leaks at all new duct connections:;:
N,
DECLARATION STATEMENTt
• I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct.
. I am the certified HERS rater who. performed the verification services identified and reported on this certificate (responsible rater).
. The installed feature, material, component, or manufactured device requiring HERS verification that is identified on this certificate (the
installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified
on the Certificate(s) of Compliance (CF -1R) approved by the local enforcement agency.
. The information reported on applicable sections of the Installation Certificate(s) (CF -611), signed and submitted by the person(s)
responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -SR) approved by the
enforcement agency.
Builder or Installer information as shown on the Installation Certificate (CF -6R)
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
HARRISON ENTERPRISES INC
Responsible Person's Name:
CSLB License:
Danielle Garcia
1686310
HERS Provider Data Registry Information
Sample Group # (if applicable): 399765
❑ tested/verified dwelling
® not-tested/verified dwelling in
la
HERS sample group
HERS Rater Information CaICERTS Certificate # CCI -1798744010
HERS Rater Company Name:
Stratz Permit Service
Responsible Rater's Name:
Responsible Rater's Signature:
Garrett Williams
Garrett Williams
Responsible Rater's Certification Number w/ this HERS Provider:
Date Signed: 4/9/2013
CC2006208
Reg: 213-A0019429A-M2100001A-M21A Registration Date/Time: 2013/04/13 16:34:29 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS
Duct Leakage Test — Existing Duct System (Page 1 of 2)
Site Address:
RIVIERA DRIVE, La Quinta CA 92253 (System
Enforcement Agency:
9 �°
Permit Number:
)4835
City of La Quinta
13-182
Enter the Duct System Name or Identification/Tag: System 1
Enter the Duct System Location or Area Served: Whole House
Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the
dwelling.
This installati
space conditl
is required for compliance for alterations and additions in existing dwellings to
s and duct systems.
Note: For existing dwellings, a completely new or replacement duct system can also include existing parts of
the original duct system (e.g., register boots, air handler, coil, plenums, etc.) if those parts are accessible
and they can be sealed. For a completely new or replacement duct system installed in an existing dwelling,
use the Installation Certificate titled "Duct Leakage Test - Completely New or Replacement Duct System. "
Duct Leakage Diagnostic Test - existing duct system.
Select one compliance method from the following four choices.
® 1. Measured leakage less than 15% of fan flow
❑ 2. Measured leakage to outside hess than 10% of Fan Flow
❑ 3. Reduce leakage by 60% and conduct smoke and fix all leaks
`all
❑ 4,Fix accessible leaks using smoke and HERS rater verify
Note "(One of Opt ons.1, 2 or 3 must be attempted„before utilizing,Option 44.)_
Determine nominal?Fan,Flow using 6ne of the following three calculation methodsF.
®Cooling yste'm method Size of condenser in Tons 3x 400'= 1200 CFM'..*
v
❑Heating fTg
VV
system met od 21 7wx Output Capacityin Thousands of Btu/hr _ CFM
a� G R ''�.. 4'R� '
❑ Measured system test_procedures:
airflow using�RA3 „3 airflow _CFM;
Option 1 use&then .:,, }�; ` ~• a"r '�N c w =
1
Allowed leakage -` Fan A1rflow1200` x 0.15 180 CFM"
Actual Leakage 91, CFM ,=R
Pass if Actual Leakage is less than Allowed leakage
®Pass Fail
Option 2 used then
2
Allowed leakage = Fan -,Airflow �L x 0.10 = _ CFM
Actual Leakage to outside. =IL`L CFM
"',4 Pass if Actual leakage to outside is less than Allowed leakage
Pass ❑ Fail
Option 3 used then:
Initial leakage prior to start of work = CFM
Final leakage after sealing all accessible leaks using smoke test = CFM
3
Initial leakage _ - Final leakage _ = Leakage reductionCFM
((Leakage reduction_/ Initial leakage x 100% _ %Reduction
Pass if % Reduction >= 60%
Pass Fail
Option 4 used then:
4
All accessible leaks repaired using smoke test. HERS rater must verify (No Sampling).
Pass if all accessible leaks have been repaired using smoke
Pass Fail
Reg: 213-A0010720A-M2100001A-0000 Registration Date/Time: 2013/04/13 16:08:17 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS
Duct Leakage Test - Existing Duct System (Page 2 of 2)
Site Address:
54835 RIVIERA DRIVE, La Quinta CA 92253 (System
Enforcement Agency:
Permit Number:
1)
City of La Quinta
13-182
® Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off
during duct leakage testing. CFI OA ducts that utilize controlled motorized dampers, that open only when OA
ventilation is required to meet ASHRAE Standard 62.2, and close when OA ventilation is not required, may
be configured to the closed position during duct leakage testing.
® All supply and ret n register`�boots must be;=sealed to the drywali, if smoke test `is Utilized for'compliance
- applies'to duct leakage compliance option 3 (leakage reduction by 60,%:}and option 4,(fiX all accessible
leaks) described above
r
® New duct installpt ons cannot utilize building cavities aspplenums or platform "returns in lieu of ducts
i s
® 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 penalty of perjury, untler the laws of the State of Califomia, the information provided on this form is true and correct.
. I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized
representative of the person responsible for construction (responsible person).
. I certify that the installed features, materials, components, or manufactured devices identified on this certificate (the installation)
conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the
enforcement agency.
• I 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 -1R) form approved by the enforcement agency that identifies the specific
requirements for the installation. I certify that the requirements detailed on the CF -111 that apply to the installation have been met.
• I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the
building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I
understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder
provides to the building owner at occupancy. I will ensure that all Installation Certificates will come from a HERS provider data
registry for multiple orientation altematives, and beginning October 1, 2010, for all low-rise residential buildings.
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
HARRISON ENTERPRISES INC
Responsible Person's Name:
Responsible Person's Signature:
Danielle Garcia
Danielle Garcia
CSLB License:
686310
Date Signed:
4/1/2013
Position With Company (Title):
Is this installation monitored by a Third Party Quality
Name of TPQCP (if applicable):
Control Program (TPQCP)? ❑ Yes ❑ No
Reg: 213-A0010720A-M2100001A-0000 Registration Date/Time: 2013/04/13 16:08:17 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010