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13-0560 (MECH)li� P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 13-00000560 Property Address: 56635 RIVIERA APN: 762 -032 -001 - Application description: MECHANICAL Property Zoning: . LOW DENSITY RESIDENTIAL Application valuation: 7250 Applicant: Architect or Engineer: ------------------ LICENSED CONTRACTOR'S DECLARATION 414 QU14 (_-1_0� _L VOICE (760) 777-7012 FAX (760) 777-7011 •BUILDING & SAFETY DEPARTMENT v INSPECTIONS (760) 777-7153 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 Pr fessionals Code, and my License is in full force and effect. License Class: C20 C36 L' nse No.: 906115 Date: ��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 permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 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).: (_ 1 I, 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 her 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.): ' 1 _ 1 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: LARRY HANSEN 56635'RIVIERA LA QUINTA, CA 92253 (760) 668 -24 86 Contractor: HYDES 42949 MADIO STREET INDIO, CA 92201 (760)360-2202 Lic. No.: -906115 Date: 5/01/13 P � [:MAY 012013 CITY OF LA QUINTA FINANCE DEPT. ----------------------------------------------- WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ._ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided f r by Section 3700 of the Labor Code, for the performance of the work for which this permit is sued. 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 NORGUARD INS Policy Number CEWC356415 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 I should become subjec t the worke compensation provisions of Section 3700 of the Labor Code, I shall forth omply those provisions. pate:17-j 3 Applicant" C WARNING: FAILURE TO SECURE ORKERS' 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 ply with all city and county ordinances and state laws relating to building construction, and reb authoriz ply of this cou ty to enter upon the above-mentioned property for inspection pu es Date: ' ,-� .� Signature (Applicant or Agent): Application Number . . . . . 13-00000560 Permit MECHANICAL Additional desc . . Permit Fee 42.50 Plan Check Fee 10.63 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 10/28/13 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 11.0000 EA MECH FURNACE >100K 11.00 1.00 16.5000 EA MECH B/C >3-15HP/>100K-500KBTU 16.50 ---------------------------------------------------------------------------- Special Notes and Comments HVAC CHANGE OUT - 13 SEER/78 AFUE [2008 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2010 CALIFORNIA BUILDING CODES. ---------------------------------------------------------------------------- Other Fees . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged Paid Credited --------------------------------------------------------- Due Permit Fee Total 42.50 .00 .00 42.50 Plan Check Total 10.63 .00 .00 10.63 Other Fee Total 1.00 .00 .00 1.00 Grand Total 54.13 .00 .00 54.13 LQPERMIT Bin # Permit .# Project Address: A. P. Number: Contractor: / Address.- City, ddress. City, ST, Zip: Tel h �- Q 3S L-, fo ep one. 6 Cj _ ZZ _Z State Lic. # Arch., Engr., Designer: Address: City, ST, Zip: Telephone: State Lic. #: Name of Contact Person: Telephone # of Contact Person: # Submittal Plan Sets Structural Calcs. Truss Calcs. Energy Calcs. Flood plain plan Grading, plan' Subcontactor List Grant Deed H.O.A. Approval IN HOUSE: - Planning Approval Pub. Wks. APpr School Fees City of La Quinta Building .& Safety Division P.O. BOX 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet s le V�FI( ame: r G ttsld,� g ^ C 35 D ip: t n 60ZC(cription: �ii •A(,,4o . C � cl ZZd� Lic. #: L -(k -L .S Z53 Construction Type: Occupancy: p cy: Project hype (circle one): New Add'n Alter Repair' p Demo Sq. Ft : #Stories: #Units: Estimated Value of Project- ..l 0 APPLICANT: DO NOT WRITE BELOW THIS UNE 'd TRACKING . PERMIT FEES Plan Check submitted Item Amount Reviewed, ready for corrections Plan Check Deposit Called Contact Person Plan Check Balance Plans picked up Construction Plans resubmitted Mechanical god Review, ready for correction&ssue Electrical Called Contact Person Plumbing Plans picked up SALL Plans resubmitted Grading Review, ready for corrections/issue Developer impact Fee Called Contact Person ALP P. Date of permit issue Total Permit Fees P Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-lR-ALT-HVAC Climate Zones 10 - 15 Site Address: Enforcement Agency: Date: 7Permit #: 56-635 Riviera La Quinta, CA 92253 City of La Quinta May 1, 2013 Duct insulation Conditioned Floor Equipment Typel List Minimum Efficiency2 requirement Area Thermostat ❑ Package Unit ® Furnace ® Indoor Coil ® AFUE 78% ® SEER 13.0 ❑ COP ❑ HSPF ❑ R 6 (CZ 10-13) Served by system ® Setback If not already present, must be ® Condensing Unit E3 EER [3 Resistance ❑ R gCZ 14-15 . ( ) 1400 sf installed) ❑ Other I , 1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF-ZR-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-4R forms (no hand filled CF-4Rs allowed) are filled out and signed.Beginning October 1, 2010, a registered copy of the CF-1R and CF-6R shall also be on site for final inspection. ® 1. HVAC Changeout Required Forms: . All HVAC Equipment CF-6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS replaced CF-4R forms: MECH-21 and (for split systems) MECH-25 • Condenser Coil and /or . Indoor Coil and /or CF-6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS . Furnace CF-411 forms: MECH-21 and (for split systems) MECH-25 For Split Systems: Duct leakage < 15 percent; RC, CCA <_ 300 CFM/ton (Minimum Air Flow Requirement), TMAH Exempted from duct leakage testing if: ❑ 1. Duct system was documented to have been previously sealed and confirmed through HERS verification, or ❑ 2. Duct systems with less than 40 linear feet in unconditioned space, or ❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos ❑ 4. Thejsystem will not be Ducted (ie. Ductless Mini-Split System) (Also Exempt from Refrigerant Charge) ❑ 2. New HVAC System Required Forms: . Cut in or Changeout with; CF-611 forms: MECH-04, MECH-20fHERS?and (for split systems) MECH-22-HERS, and new ducts: (all new 1.MECH-25-HERS ( r / dulling and all new CF-411 forms: MECH-20, and (for split systems) MECH-22, and MECH-25 equipment) I For Split Systems: Duct leakage < 6 percent; RC, CCA >_ 350 CFM/ton, FWD, TMAH, STMS, and either HSPP or PSPP. " For Packaged Units: Duct leakage < 6 percent ❑ 3. New Ducts with/or without Required Forms: Replacement • Includes replacing or installing all new ducting and/or outdoor condensing unit CF-6R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS and/or indoor coil and/or furnace. No or some CF-411 forms: MECH-20 and (for split systems) MECH-25 equipment changed. For Split Systems: Dud leakage < 6 percent; RC, CCA >_ 300 CFM/ton, TMAH For Packaged Units: Dud leakage < 6 percent ❑ 4. New Ducting over 40 feet Required Forms: . Includes adding or replacing more than 40 CF-6R forms: MECH-04, MECH-2I-HERS linear feet of dud in unconditioned space. CF-4R forms: MECH-21 For split system or packaged units: Dud leakage < 15 percent ❑ 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 California 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: Mark Hyde Signature: Mark Hyde Company: CERTIFIED COMFORT SYSTEMS INC Date: May 1, 2013 Address: 42-949 MADIO STREET License: 906115 City/State/Zip: INDIO / CA/ 92201 Phone: (760) 360-2202 Reg: 213-A0026057A-000000000-0000 Registration Date/Time: 2013/05/01 13:28:08 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: Enforcement Agency: Permit Number: 56-635 Riviera, La Quinta CA 92253 (System 1) City of La Quint a 13-560 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 install space cond is required for compliance for alterations and additions in existing dwellings 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 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. before utilizing Option 4.) Determine nomina1,Fap,�Flow using one,of the,,following three calculationgmethods. ✓ ❑ Coolingfs stem mco ethod: Size of nden es � in Tons - x`400;=r 4 UK ✓ 13Hea�tting'system method"21 7 x • Output Capacity in,Thousands of Btu/hr = _CFM ✓❑ Measured system airflow using'RA3.3.airflow,testiprocedures: r CFM,';,;..-wr Option'1 used then: kA. t ~r '14, , �.�# ,�. ` 7 ►t a6~. x." �iseC� Allowed leakage ='Fan Flow i_ z 0 CFM " � �1 %+' ' 1 15, -- Actual Leakage ,\ =_ CFM __ '-' �.— ^, +r Pass if Leakage Actual is less than Allowed Pass Fail Option 2 used then: J 2 Allowed leakage = Fan Flow j_ x 0.10 = _ CFM - Actual Leakage to outside = r. CFM y 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% r3 Pass n 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 0 * r Reg: 213-A0026057A-M2100001A-M21A Registration Date/Time:,2013/06/08 18:00:08 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms, March 2010 h CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-21 Duct Leakage Test Existing Duct System (Page 2 of 2) Site Address: Enforcement Agency: Permit Number: 56-635 Riviera, La Quinta CA 92253 (System 1) City of La Quinta 13-560 � 1 ❑ 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 andxreturn register boots• must, be, sea ledAolthe drywallrif.smokeJtestlis,utilized,for,compliance - applies to, leakage.compliance�opt'ion'3'(leakege' e6auction t;y,600/oNndPoption14`(fix all accessible leaks) described above. j13c'f ❑ New duct,installations.cannot(futlllze`.building cavities as plenums or.platformsreturns in.lieu bf ducts:.. �} •. _U7- � ❑ Mastic and,draw bands, must�be usediinrcombination;with' cloth backedtrubber adhesive,duct tape;to•seal'fi leaks at all new duct connections: `'.�i.. `m 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 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 -111) approved by the enforcement agency. Builder or Installer information as shown on the Installation Certificate (CF -611) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) CERTIFIED COMFORT SYSTEMS INC Responsible Person's Name: 7--FC—SLB License: Mark Hyde 906115 HERS Provider Data Registry Information • t � � 1 ❑ 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 andxreturn register boots• must, be, sea ledAolthe drywallrif.smokeJtestlis,utilized,for,compliance - applies to, leakage.compliance�opt'ion'3'(leakege' e6auction t;y,600/oNndPoption14`(fix all accessible leaks) described above. j13c'f ❑ New duct,installations.cannot(futlllze`.building cavities as plenums or.platformsreturns in.lieu bf ducts:.. �} •. _U7- � ❑ Mastic and,draw bands, must�be usediinrcombination;with' cloth backedtrubber adhesive,duct tape;to•seal'fi leaks at all new duct connections: `'.�i.. `m 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 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 -111) approved by the enforcement agency. Builder or Installer information as shown on the Installation Certificate (CF -611) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) CERTIFIED COMFORT SYSTEMS INC Responsible Person's Name: 7--FC—SLB License: Mark Hyde 906115 HERS Provider Data Registry Information Sample Group # (if applicable): 418085 ❑ tested/verified dwelling ® not-tested/verified dwelling in la HERS sample group HERS Rater Information CaICERTS Certificate # CC1-1798751787 HERS Rater Company Name: Desert H.E.R.S. Raters Responsible Rater's Name: Responsible Rater's Signature: Michael Hyde Michael Hyde Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 5/30/2013 CC2005602 , Reg: 213-A0026057A-M2100001A-M21A Registration Date/Time: 2013/06/08 18_:00:08 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 , t CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 6) Site Address: Enforcement Agency: Permit Number: 56-635 Riviera, La Quinta CA 92253 City of La Quinta 1 13-560 Note: If installation of a Charge Indicator Display (CID) is utilized as an alternative to refrigerant charge verification for compliance, a MECH-24 Certificate (instead of this MECH-25 Certificate) 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 additional form(s) for any additional systems in the dwelling as applicable. Temperature Measurement Access Holes (TMAH) and Saturation Temperature Measurement Sensors (STMS) Procedures for installing TMAH are specified in Reference Residential Appendix RA3.2. If refrigerant charge verification is required for compliance, TMAH are also required for compliance, unless the TMAH Compliance Option is chosen.' STMS are only required for completely new or replacement space -conditioning systems that utilize prescriptive compliance method. TMAH - Access Holes in SuoDly and Return Plenums of Air Handler System Name or Identification/Tag System 1 System Location or Area Served Whole House 5/16 inch (8 mm) access hole 1 upstream of evaporative coil in the ❑ Yes ❑ Yes ❑ Yes ❑ Yes return plenum and labeled according ❑ No ❑ No ❑ No ❑ No to FigurerinjSection RA3.2.2;2:2. ,,pw" , .-1,, Return [side of ithe duct system is •' ;� V • s' {� ' la located entirely withinfconditioned .' space and return airflow temperature ❑Yes ❑;No;,, ❑^Yes, �r"�'0 No !-icy, „ ti ❑ No ❑ Yes ❑,No to�be measuredt the.retur`n{grille: - „.:.-_--^-„' ; i xt ,,'► ,, 5/16-inc�(8Fmm)"access+holed r�^'.Ft"•x► ti downOF stream:of evaporativewcoil w�, r..w.. ..T -y .h A c4 ► 2 in,the .�- ❑ Yes.<,* ❑Yes �r ❑Yes ❑Yes supply plenum and labeled according ❑ No ❑ No ❑ No ❑ No to Figure, in -Section RA3.2.2.2.2. The TMAH Compliance Option should be checked only if the HERS Rater is able to confirm that it was physically impossible for the HVAC Installer to drill the TMAH as required by Section RA3.2.2.2.2. Using this Compliance Option requires the HVAC installer to annotate on the HERS Provider's data registry an explanation as to why the TMAH cannot be installed on the system, and photographs of the equipment on which the TMAH cannot be installed. Use of this Compliance Option also requires minimum airflow - verification through the direct measurement of airflow per RA3.3. For more information see htto://www.enerav.ca.aov/title24/2008standards/special case appliance/ TMAH Compliance Option p p ❑ p Yes to 1 and 2, or Yes to la and 2, or checking the TMAH Compliance Option, is p Pass O Pass ❑ Pass ❑ Pass a pass. ❑ Fail ❑ Fail ❑ Fail. ❑ Fail Enter Pass or Fail X 0 Reg: 213-A0026057A-M2500001A-M25A Registration Date/Time: 2013/06/08 18:02:39 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance'Forms I February 2013 CERTIFICATE OF.FIELD VERIFICATION & DIAGNOSTIC TESTING. CF-411-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 6) Site.Address: . • - IEnforcement Agency: Permit Number: 56-635 Riviera, La Quinta CA 92253 City of La Quinta 1 13-560 STMS - Sensor on the Evaporator Coil System Name or T_ . i 4;7 Identification/Tag ; 3 The sensor is factory installed, or field installed according to manufacturer's specifications, or is installed by methods/specifications approved by the Executive Director. ❑ Yes ❑ No 1 ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No The sensor wire is terminated with a standard mini plug suitable for connection to a digital thermometer. 4 The sensor mini plug is accessible to the installing technician and the HERS rater without changing the airflow through the condenser coil ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No 5 When attached to a digital thermometer, the sensor provides an indication of the saturation temperature of the coil. ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No Yes to 3, 4, and 5,is a - pass. Enter N/A if STMS are not ❑ N/A ❑ N/A ❑ N/A ❑ N/A. applicable. ❑ Pass ❑ Pass " ❑ Pass ❑ Pass Otherwise enter Pass or ❑ Fail ❑ Fail ❑ Fail ❑ Fail Fail j STMS - Sensor on the Condenser Coil System Nam6-76 - e4le` System i"�M . i 4;7 Identification/Tag t'.'4` ; 6 The sensor is factorylinstalledO or field installedjaccord'ing to"manufacturer's�specificatiohns,.or is installed by methods/specifications,appr`ovea;Dy the Executivelbirector:''{°;"rr,', �[ + A1 -Is .. j),Z]Yes:❑Nod! ; ,, ❑Yes ❑?Nom. ❑ Yes ;❑Noh j;❑YestONod(,;. The sensor!'wire;is:terminated�with�a,standardimini•plug(suitable for -connection to'a!digital thermometers 7 The sensor mini plug is accessible to the installing technician and'the HERS rater without changing the airflow through,the condense.Fcoil , 10 Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No 8 When attached to a digital thermometer, the sensor provides an indication of the saturation temperature of the coil. J ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes []No ❑ Yes ❑ No Yes to 6, 7, and 8 is a - pass. Enter N/A if STMS are not ❑ N/A ❑ N/A ❑ N/A ❑ N/A applicable. � 13 Pass 171 Pass El Pass El Pass Otherwise enter Pass or El Fail ❑ Fail ❑ Fail . ❑ Fail Fail . Reg: 213-A0026057A-M2500001A-M25A Registration Date/Time: 2013/06/08 18:02:39 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms February 2013 . i 1 Reg: 213-A0026057A-M2500001A-M25A Registration Date/Time: 2013/06/08 18:02:39 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms February 2013 INSTALLATION CERTIFICATE CF-4R-MECH-2E tefrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 6; Site Address: Enforcement Agency: Permit Number: 56-635 Riviera, La Quinta CA 92253 City of La Quinta 1 13-560 Standard Charge Measurement Procedure (for use if outdoor air dry-bulb is above 55°F) z Procedures for determining Refrigerant Charge using the Standard Charge Measurement Procedure are available in Reference Residential Appendix RA3.2. As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional form(s) for any additional systems in the dwelling as applicable. • The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure. • The system must meet minimum airflow requirements as prerequisite for a valid refrigerant charge test. • If outdoor air. dry-bulb temperature is less than 55°F, the installer must use the RA3.2.3 Alternate Charge Measurement Procedure (Weigh -In Charging'Method). If the Weigh -In Method is used, the dwelling cannot be included in a sample group for HERS verification compliance.) Space Conditionin4 Svstems System Name or Identification/Tag System 1 -,sem ��. (must be re -calibrated monthly r• System Location or Area Served Whole.House (must be re -calibrated monthly) Outdoor Unit Serial # Outdoor Unit Make Outdoor Unit Model` Nominal Cooling Capacityµ Date of Ve f cationy -r 'fit Calibratio � of Diagnostic Instru.iments '0` i .! .. � A ^1+•-•rte�..�.. c 7�x Rif Date of Refrigerant Gauge:Calibration ice'• s k' ; �,'; �.�t.aia. N_ ..,w:T _ . ,.. -,sem ��. (must be re -calibrated monthly r• Supply (evaporator leaving) air dry-bulb Date of Thermoc uple Calibration (must be re -calibrated monthly) temperature (Tsu I db) Measured Temperatures'(°Fl System Name or Identification/Tag System 1 Supply (evaporator leaving) air dry-bulb temperature (Tsu I db) Return (evaporator entering) air dry-bulb temperature (Treturn •db) Return (evaporator entering) air wet -bulb temperature (Treturn wb) Evaporator saturation temperature (Teva orator sat) Condensor saturation temperature (Tcondensor, sat) ` Suction line temperature (Tsuction) Liquid Line Temperature (Tliquid) Condenser (entering) air dry-bulb temperature (Tcondenser, db) Reg: 213-A0026057A=M2500001A-M25A Registration Date/Time: 2013/06/08 18:02:39 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms February 2013 Zwl r INSTALLATION CERTIFICATE CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 6) Site Address: Enforcement Agency: Permit Number: 56-635 Riviera, La Quinta CA 92253 City of La Qu 1 13-560 Minimum Airflow Requirement Temperature Split Method Calculations for determining Minimum Airflow Requirement for Refrigerant Charge Verification. The temperature split method is specified in Reference Residential Appendix RA3.2. System Name or Identification/Tag Calculate: Actual Temperature Split = Treturn, - db - Tsupply, db Target Temperature Split from Table RA3.2-3 using Treturn wb and Treturn db Calculate difference: Actual Temperature Split - Target Temperature Split = Passes if difference is between -4°F and +4°F or, upon remeasurement, if between -4°F and -100°F ' Enter Pass or Fail ' Note: Temperature Split Method Calculation is not necessary if actual Cooling Coil Airflow is verified using one of the airflow measurement, procedures specified in Reference Residential Appendix RA3.3. If actual cooling coil airflow is measured, the value must be equal to or greater than the Calculated Minimum Airflow Requirement in the table below. L__ h --- ---- ',` fret# TV 1.►"''..�lv x- ;Im..- '�,ti Calculated;Minimum Airflow Requirement (CFM) Nminal Cooling Capacity (ton) X,300 ro �• � � `a�y� ,,�+ • (cfm/ton) �- �� , � _ ,•i. r ' . 'E,'�j'� { � y. �, � }i � 5�..►�r ,.r'E, :elk .klla. r� S stem Name or Identification Ta � '� ,,,,, _`� �� .�`"�� l� i• +� '�' Calculated Minimum Airflow Requirement (CFM) �.•--'�. V - Measured Airflow using RA3.3,procedures (CFM), Measurement Method Passes if measured airflow is greater than or equal to the calculated minimum airflow requirement. Enter Pass or Fail Reg: 213-A0026057A-M2500001A-M25A Registration Date/Time: 2013/06/08 18:02:39 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms February 2013 , s - - Reg: 213-A0026057A-M2500001A-M25A Registration Date/Time: 2013/06/08 18:02:39 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms February 2013 , s - INSTALLATION CERTIFICATE CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 6) Site Address: Enforcement Agency: Permit Number: 56-635 Riviera, La Quinta CA 92253 City of La Quinta 13-560 Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for fixed orifice metering device systems System Name or Identification/Tag systems.. System Name or Identification/Tag Calculate: Actual Superheat = Calculate: Actual Superheat = Tsuction - Teva orator sat Tsuction - Teva orator sat Target Superheat from Table RA3.2-2 using Enter allowable superheat range from Treturn wb and Tcondenser, db manufacturer's specifications (or use range Calculate difference: " between 3°F and 26°F if manufacturer's Actual Superheat - Target Superheat = ' '� ►'� Q4 System passes if difference is between -6°F System passes if actual superheat is within and +6°F the allowable superheat range Enter Pass or Fail Enter Pass or Fail Subcooling Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag systems.. System Name or Identification/Tag Calculate: Actual Subcooling =; Calculate: Actual Superheat = Tcondenser, sat - Tli uid Tsuction - Teva orator sat Target Subcooling specified by manufacturer Enter allowable superheat range from t manufacturer's specifications (or use range Calculate difference:* 'S ��^— Actual Subcooling -)Target Subcooling?=,� " between 3°F and 26°F if manufacturer's System passes if difference is between -4°F an'd +4°F ! 1` ' '� ►'� Q4 System passes if actual superheat is within ,f'.;Enter,Pass`or Fail F Metering Device, Calculations. for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems.. System Name or Identification/Tag Calculate: Actual Superheat = Tsuction - Teva orator sat Enter allowable superheat range from manufacturer's specifications (or use range between 3°F and 26°F if manufacturer's specification is not available) System passes if actual superheat is within the allowable superheat range Enter Pass or Fail Reg: 21'3-A0026057A-M2500001A-M25A Registration Date/Time: 2013%06/08 18:02:39 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms February 2013 INSTALLATION CERTIFICATE CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 6 of 6) Site Address: IEnforcement Agency: Permit Number: 56-635 Riviera, La Quinta CA 92253 City of La Quinta 13-560 Standard Charge Measurement Summary: System shall pass both refrigerant charge criteria, metering device criteria (if applicable), and minimum cooling coil airflow criteria based on measurements taken concurrently during system operation. If corrective actions were taken, all applicable verification criteria must be re -measured and/or recalculated. System Name or Identification/Tag System 1 906115 HERS Provider,Data Registry; Information Sample Group # (if applicable): 418085 System meets all refrigerant charge and ® not-tested/verified dwelling V, in a HERS sample group airflow requirements. HERS Rater Company Name: Desert H.E.R.S. Raters Responsible Rater's Name: Responsible Rater's Signature: Enter Pass or Fail Michael Hyde Responsible Rater's Certification Number w/ this HERS Date Signed: 5/30/2013 Provider: 1 , ❑ Residential Appendix RA3.2.2 requires that if the outdoor temperature is between 55°F and 65°F the return air dry bulb temperature shall be maintained above 70°F during the Standard Charge Measurement Procedure. The signature of the Responsible Person in the declaration statement below certifies this requirement has been met for all applicable system verifications reported on this certificate. 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 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 -6R), signed and submitted by the person(s) responsible for the installation �conforms to,the,requirements-specified on,the-Certificate(s)Compliance (CF-1R).aparo.ao."`,�� Y ve&bv the enforcementencv. 4 'i 'r r I _t �► Builder,br'Installer information_'as, shown'on ,the'Installation Certificate,(CF-6R)- Company•Name: (Installing Subcontractor or General,Cdntractor or.-Builder/Owner) _ CERTIFIED COMF{ORT�SYSTEMS INC ,� . `F ' �i'z� "� �'�,....- S �-""' ,°oil=' ,r'r, Responsible P,erson:,s Name:( ;; CSL B`License: 4ack;'r,�•�A,(f',(;,,�?i Mark Hyde ,� ,-� +.,,. _ ` '.R TM 906115 HERS Provider,Data Registry; Information Sample Group # (if applicable): 418085 ❑ tested/verified dwelling ® not-tested/verified dwelling V, in a HERS sample group HERS Rater Information Ca10ERTS Certificate # CCi-1798751787 HERS Rater Company Name: Desert H.E.R.S. Raters Responsible Rater's Name: Responsible Rater's Signature: Michael Hyde Michael Hyde Responsible Rater's Certification Number w/ this HERS Date Signed: 5/30/2013 Provider: CC2005602 5 Reg: 213-A0026057A-M2500001A-M25A Registration Date/Time: 2013/06/08 18:02:39 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms February 2013 INSTALLATION CERTIFICATE CF-6R-MECH-04 Space Conditioning Systems, Ducts and Fans (Page 1 of 2) Site Address:Enforcement Agency: Permit Number: ` 56-635 Riviera, La Quinta CA 92253 (System I I I City of La Quinta 13-560 Space Conditioning Systems Heating Equipment , Equip Type (package- heat pump) J. CEC Certified Mfr. Name and Model Number ARI Reference Number2 # of Identical Systems i Efficiency (AFUE, etc.)1, 3 (>=CF -1R value)4 Duct Location (attic, crawl- space, etc.) Duct R -value Heating Load (kBtu/hr) Heating Capacity (kBtu/hr) Split Furnace american standard aud1c100a9481ab 1 80 AFUE Attic • R-4.2 80 100 kl3tu Type and EER) (attic, (package ARI # of 1, 3 crawl- Cooling Cooling heat -CEC Certified Mfr. Name Reference Identical (>=CF -SR space, Duct Load Capacity pump) and Model Numbed Number2 Systems value)4 etc.) R -value (kBtu/hr) (kBtu/hr) Split american standard 13 SEER c.00nng cquipmenr 1. !r projecr Is new consrruccion, see roornares ro _-.1ranaaras laole 1.11-tl ana laole 1.51-L ror auct Cel/!ng atternative compliance. V- 2. ARI Reference Number can be found by entering the equipment model number at http://www.aridirectory. orglari/ac: php# 3. Listed efficiency on this page must be greater than or equal ( ? ) to the value shown on the CF -1R form. 4. When CF -1R is reference it is also applicable to the CF -1R, CF -IR -AA or CF-ZR=ALT ALL BOXES MUST BE.CHECKED TO BE A VALID FORM ® §110-§113: HVAC equipment is certified by the California Energy Commission. R §150(h): Heating and/or cooling loads calculated in accordance with ASHRAE, SMACNA, or ACCA. H §150(i): Setback Thermostat on all applicable heating and/or cooling systems meet the requirements of §112(c). I - ® §150(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. s Reg: 213-A0026057A-M0400001A-0000 Registration Date/Time: 2013/05/07 20:24:24 HERS Provider: CalCERTS, Inc. 2008 Residential.Compliance Forms August 2009 v i Efficiency Duct Equip (SEER Location Type and EER) (attic, (package ARI # of 1, 3 crawl- Cooling Cooling heat -CEC Certified Mfr. Name Reference Identical (>=CF -SR space, Duct Load Capacity pump) and Model Numbed Number2 Systems value)4 etc.) R -value (kBtu/hr) (kBtu/hr) Split american standard 13 SEER A/C _ $W4ttb3042d1000ba � �l+�r� . ,11aEER' K 1"ttic7pm WR-4-2*q A440 42 kBtu 3-X21 ila�f w� � {Y - �» 1 'mss ��. f( •1.Yyfr�y t � r�,} 4p"�.Sy y�� ti 'J ys�4l s L�)'4 Y:1 [ " ��„ i .7c.� _3� -� •: ,�Jy, �.,y;�,ca' r,��,7'�F3-.e! :i�' r'-�"''. 's... -�i r..Y� f 1. !r projecr Is new consrruccion, see roornares ro _-.1ranaaras laole 1.11-tl ana laole 1.51-L ror auct Cel/!ng atternative compliance. V- 2. ARI Reference Number can be found by entering the equipment model number at http://www.aridirectory. orglari/ac: php# 3. Listed efficiency on this page must be greater than or equal ( ? ) to the value shown on the CF -1R form. 4. When CF -1R is reference it is also applicable to the CF -1R, CF -IR -AA or CF-ZR=ALT ALL BOXES MUST BE.CHECKED TO BE A VALID FORM ® §110-§113: HVAC equipment is certified by the California Energy Commission. R §150(h): Heating and/or cooling loads calculated in accordance with ASHRAE, SMACNA, or ACCA. H §150(i): Setback Thermostat on all applicable heating and/or cooling systems meet the requirements of §112(c). I - ® §150(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. s Reg: 213-A0026057A-M0400001A-0000 Registration Date/Time: 2013/05/07 20:24:24 HERS Provider: CalCERTS, Inc. 2008 Residential.Compliance Forms August 2009 v i INSTALLATION CERTIFICATE CF-6R-MECH-04 Space Conditioning. Systems, Ducts and Fans (Page 2 of 2) Site Address: Enforcement Agency: Permit Number: 56-635 Riviera, La Quinta CA 92253 (System 1) City of La Quinta 13-560 Ducts and Fans §150(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 UL 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 ❑ 1. Building cavities, support platforms for air handlers, and plenums defined or constructed with materials other than sealed 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-sectional area of the ducts. E3 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. ❑ 8. Gravity ventilating systems serving conditioned space have either automatic or readily accessible, manually operated dampers. ❑ Protection of Insulation.+Insulation shall 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. Q C DECLARATION STATEMENT i • 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 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 -111) 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. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) CERTIFIED COMFORT SYSTEMS INC Responsible Person's Name: Responsible Person's Signature: Mark Hyde Mark Hyde CSLB License: 906115 Date Signed: 5/7/2013 Position With Company (Title): + Reg: 213-A0026057A-M0400001A-0000 Registration Date/Time: 2013/05/07 20:24:24 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS Duct Leakage Test — Existing Duct System (Page 1 of 2) Site Address: Enforcement Agency: Permit Number: 56-635 Riviera, La Quinta CA -92253 (System 1) City of La Quinta 13-560 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 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 Options 1, 2 or 3 must be attempted before utilizing Option 4.) Determine nominal -Fan Flow using one of the. following three calculation methods. ✓ ® Cooling*system method: Size of.condenser in Tons3 5 x 40 11 0 — +1400 CFM ✓ ❑ Al Heating; system method 7 x�� Output Capacity in,Thousands of Btu/hr = CFM _ ✓❑Measured %i "7^^s��; systemrairflow using; -1 1 3'airflow�testiprocedures: •CFM �-+r--" .,os H �� O tion'4 used'.then ' WA P s.. --r,._ ..� �, r:'4ir�p 1 r�:, i ._.,,� .+�, • ':. x'1400- i� it �e3 1 Allowed leakage' ,Fan Airflow x 0:15 210 , CFM-< ^L..• Actual Leakage = 191 CFM.;, • E I. Pass if Actual Leakage is less than Allowed leakage Pass Fail Option 2 used then: . 2 Allowed leakage = Fan Airflo wl�, c x 0.10 = CFM Actual Leakage to outside = 1_ CFM Y I 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 >= 600/0 O 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 13 Pass rj Fail iE 0 ID Reg: 213-A0026057A-M2100001A-0000 Registration Date/Time: 2013/05/07 17:56:02 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: Enforcement Agency: Permit Number: 56-635 Riviera, La Quinta CA 92253 (System 1) City of La Quinta 13-560 ' ® 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. IN All supplyanndrreturn register boots•must7beysealecl ttory otthe dwall if�smoke test is utiliz.ed.for�compliance — applies oto Wct leakage compliance option'3 (leakage redu_ctlon b`y�60 /o,) and optionj4 (fix all accessible leaks) described above. jr �� At ® New duct installatio s cannot. utilizelbuilding cavities aspplenums or platformireturns in liewbf.ducts.- „�� r, ® Mastic and drawrbandsAmust be*usecl�n,combinatlon,wlthecloth backedcrubber,,,adhesive cluct;tapep seal leaks at all'new duct' connectionsr �_= rz«- * ri t ':^"�{ ' ~ *^ " ':mss=* ' ..*_ . 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 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 alternatives, and beginning October 1, 2010, for all low-rise residential buildinas. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) CERTIFIED COMFORT SYSTEMS INC Responsible Person's Name: Responsible Person's Signature: Mark Hyde Mark Hyde CSLB License: 906115 Date Signed: 4/23/2013 Position With Company (Title): Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? p Yes p No Reg: 213-A0026057A-M2100001A-0000 Registration Date/Time: 2013/05/07 17:56:02 HERS Provider: CalCERTS, Inc. 2008 Residential`Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-6R-MECH-2S-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 6) Site Address: Enforcement Agency:713-560 Permit Number: 56-635 Riviera, La Quinta CA 92253 City of La Quinta Note: If installation of a Charge Indicator Display (CID) is utilized as an alternative to refrigerant charge verification for compliance, a MECH-24 Certificate (instead of this MECH-25 Certificate) 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 additional form(s) for any additional systems in the dwelling as applicable. Temperature Measurement Access Holes (TMAH) and Saturation Temperature Measurement Sensors (STMS) Procedures for installing TMAH are specified in Reference Residential Appendix RA3.2. If refrigerant charge verification is required for,compliance, TMAH are also required for compliance, unless the TMAH Compliance Option is chosen. a STMS are only required for completely new or replacement space -conditioning systems that utilize prescriptive compliance method. TMAH - Access Holes in Supplv and Return Plenums of Air Handler System Name or Identification/Tag System 1 System Location or Area Served Whole House 5/16 inch (8 mm) access hole 1 upstream of evaporative coil in the ® Yes ❑ Yes ❑ Yes ❑ Yes return plenum and labeled according ❑ No ❑ No ❑ No ❑ No to Figure int ection RA3.2.2.2.2.- Return'side of`the duct system is"`' r located bntirely within conditioned Y '': ® Yes °` xo" , ❑Yes"' ' i❑ Ye ' t&- i : ❑ Yes space and return�airflow,temperature ❑ No 'No r ❑ No � ) E) No to ie measured at tK6,ree0h 5/1'6,inch (8 mm) access hole downstream of evaporative'cotl in.the �' ®Yes -+ 4 ❑,Yes' I:T ❑Yes ❑,Yes 2 supply plenum and labeled''according� t ,� ❑ No " ' ❑ No' ❑ No ,,i ❑ No to Figure in,Section RA3.2.2.2.2. The TMAH Compliance Option should be checked only if it is physically impossible to drill the TMAH as required by Section RA3.2.2.2.2.. Using this Compliance Option requires the HVAC installer to annotate on the HERS Provider's data registry an explanation as to why the TMAH cannot be installed on the system, and photographs of the equipment on which the TMAH cannot be installed. Use of this Compliance Option also requires minimum airflow verification through the direct measurement of airflow per RA3.3 For more information see http://www.energy.ca.ciov/title24/2008standards/special case appliance/ TMAH Compliance Option ❑ ❑ ❑ ❑ Yes to 1 and 2, or Yes to la and 2, or checking the TMAH Compliance Option, is ® Pass ❑ Pass ❑ Pass ❑ Pass a pass. E3 Fail ❑ Fail ❑ Fail ❑ Fail Enter Pass or Fail X 0. 9 f Reg: 213-A0026057A-M2500001A-0000 Registration Date/Time: 2013/05/07 17:55:12 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2013 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 6) Site Address: Enforcement Agency: Permit Number: 56-635 Riviera, La Quinta CA 92253 City of La Quinta 13-560 STMS - Sensor on the Evaporator Coil System Name or System 1 Identification/Tag �System � ;v"wa� 3 The The sensor is factory installed, or field installed according to manufacturer's specifications, or is installed methods/specifications approved by the Executive Director. ❑ Yes 0 No 1 ❑ Yes 0 No ❑ Yes ❑ No 0 Yes ❑ No .�:'_�,N The sensor wire is terminated with a standard mini plug suitable for connection to a digital thermometer. 4 The sensor mini plug is accessible to the installing technician and the HERS rater without changing the 7 airflow through the condenser coil ❑ Yes 0 No ❑ Yes 0 No ❑ Yes ❑ No 0 Yes ❑ No 5 IThe sensor measures the saturation temperature of the coil within 1.3 degrees F -,, ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes 0 No ❑ Yes 0 No ❑ Yes ❑ No 0 Yes ❑ No Yes to 3, 4, and 5 is a ❑ Yes ❑ No Yes to 6, 7, and 8 is a f pass. Enter N/A if STMS are not 0 N/A ❑ N/A ❑ N/A ❑ N/A applicable. ❑ Pass ❑ Pass ❑ Pass ❑ Pass Otherwise enter Pass or ❑ Fail ❑ Fail " ❑ Fail ❑ Fail Fail ❑ Fail Fail STMS - Sensor on the Condenser Coil System Name or 1 T Identification/T f_ -a9 . �System � ;v"wa� Te sensor is factory installed;iorfield;installed according'to�manufacturer'sfspecifications, or is installed methods/specifications approved'by the Executive,Director.�_?``•fps .�:'_�,N i{: ),,0gYesi 0 No r:j,❑ Yes;0,N o, „ f ❑ Yes 0 N Y- ❑ Yes; ❑,No, The sensor wire'is terniinated'with,a stand'ardlmini plug' su'itableSfor.�connection'to aidigital thermometer;,f 7 The sensor -*m ni,pl g;is acre siblelto-the. installing`technician;andithe HERS rater without cFianging the' "": , , ,.... airflow through`the,condenser`.coil �:;�y.� -,, ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No 8 IThe sensor measures the saturation temperature of the coil within 1.3 degrees F I ID Yes ❑ No • ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No Yes to 6, 7, and 8 is a f pass. Enter N/A if STMS are not ❑ N/A 11N/A ElN/A ElN/A applicable. ❑ Pass ❑ Pass ❑ Pass ❑ Pass Otherwise enter Pass or ❑ Fail ❑ Fail ❑Fail ❑ Fail Fail r t Reg: 213-A0026057A-M2500001A-0000 Registration Date/Time: 2013/05/07 17:55:12 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2013 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 6) Site Address: Enforcement Agency: Permit Number: 56-635 Riviera, La Quinta CA 92253 1 City of La Quint a 13-560 Standard Charge Measurement Procedure (for use if outdoor air dry-bulb temperature is 55°F or above) Procedures for determining Refrigerant Charge using the Standard Charge Measurement Procedure are available in Reference Residential Appendix RA3.2. As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional form(s) for any additional systems in the dwelling as applicable. • The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure. • The system must meet minimum airflow requirements as prerequisite for a valid refrigerant charge test. • If outdoor air dry-bulb temperature is less than 55°F, the installer must use the RA3.2.3 Alternate Charge Measurement Procedure (Weigh -In Charging Method). If the Weigh -In Method is used, the dwelling cannot be included in a sample group for HERS verification compliance.) • Space Conditioninq Systems System Name or Identification/Tag System 1 (must betre=calitirated7'� �, ;, .:� r r gas System Location or Area Served Whole House 4/23/2013 (must be re -calibrated r Outdoor Unit Serial # 13062ypr3f Outdoor Unit Make1 american l standard Outdoor Unit Model 4ttb3042d1000ab Nominal Cooling tCaapacity 3.5 Tons [Date ofV erificationt+'If,�'= 4%23/ 201�;,, Condenser (entering) air dry-bulb 85 .ems Calibration of Diagnostic Instruments o � ~' N.' -'� .t ��' * Date of Refrigerant Gauge Calibration, : - 'w""'_''. ; „_ 4/23/2013 ` ` (must betre=calitirated7'� �, ;, .:� r r gas monthly) Date of Thermocouple Calibration 4/23/2013 (must be re -calibrated r temperature (Tsu I db) monthly) Measured Temperatures ('F) System Name or Identification+/Tag System 1 Supply (evaporator leaving) air dry-bulb temperature (Tsu I db) 39.4 ' Return (evaporator entering) air dry-bulb temperature (Treturn db) 101.7 Return (evaporator entering) air wet -bulb temperature (Treturn wb) Evaporator saturation temperature 39.4 ' (Teva orator sat) Condensor saturation. temperature 101.7 (Tcondensor, sat)• Suction line temperature (Tsuction) 63.1 Liquid Line Temperature (Tliquid) 87.1 Condenser (entering) air dry-bulb 85 temperature (Tcondenser, db) 6 Reg: 213-A0026057A-M2500001A-0000 Registration Date/Time: 2013/05/07'17:55:12 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2013 f INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard, Measurement Procedure (Page 4 of 6) Site Address: Enforcement Agency:7113-560 ermit Number: '56-635 Riviera, La Quinta CA 92253 City of La Quinta Minimum Airflow -Requirement Temperature Split Method Calculations for determining Minimum Airflow Requirement for Refrigerant Charge Verification. The temperature split method is specified in Reference Residential Appendix RA3.2. System Name or Identification/Tag 'System 1 Calculate: Actual Temperature Split = Treturn db - Tsupply, db ' Target Temperature Split from Table RA3.2-3 using Treturn wb and Treturn db Calculate difference: Actual Temperature Split - Target Temperature Split = Passes if difference 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 Coil Airflow is verified using one of the airflow measurement procedures specified in Reference Residential Appendix RA3.3. If actual cooling coil airflow is measured lathe value must be equal to or greater than the Calculated Minimum Airflow Requirement in the table below. , y{ Calculated Minimum Airflow Requirement.F(CFM)•' Nommal!Cooling!Capac�ty (ton)_Xt300 SystemkName or)JIdyenti fitetion/Tag 'I'll System,111 11f { 1131 ek, Calculated Minimum Airflow Requirement 1050 (CFM) Measured.Airflow using RA3.3 procedures 1295 (CFM) Measurement Method ti - Flow Hood Passes if measured airflow'is greater than or equal to the calculated minimum airflow PASS requirement. , Enter Pass or. Fail Y r + • f Reg: 213-A0026057A-M2500001A-0000 Registration Date/Time: 2013/05/07 17:55:12 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms.' March 2013 INSTALLATION CERTIFICATE CF-6R-MECH-2S-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 6) Site Address: Enforcement Agency: Permit Number: 56-635 Riviera, La Quinta CA 92253 City of La Quinta 1 13-560 Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for fixed orifice metering device systems System Name or Identification/Tag System i Calculate: Actual Superheat = .14.6 Tsuction - Teva orator sat 23.7 Target Superheat from Table RA3.2-2 12 using Treturn wb and Tcondenser, db Calculate difference: ' '"l 2.6 Actual Superheat - Target Superheat = PASS' 66 1 d System passes if difference is between ` 't , -5°F and +5°F Enter Pass or Fail PASS - U Subcooling Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag System 1 Calculate: Actual Subcooling =1 .14.6 Tcondenser, sat - Tli uid 1. 23.7 Target Subcooling specified by j 12 manufacturer Calculate difference: L— Actual Subcooli—n'dl - Target Subcooling`f '"l 2.6 System passes if difference is between`, -3°F and +3°F y, � f PASS' 66 1 d jEnterdPass(or ` 't , frigerant,Charge Verification.This procedure is required to be Meteri g evice;Calculations.for Re ., used for thermostaticexpansionivalve,'(TXV),and`electronic expansioh iMve'(EXV) systems. r• System�NameroF Identification/Tag System 1 r Calculate: Actual Superheat = 23.7 Tsuction - Teva orator sat` Enter allowable superheat range from manufacturer's specifications (or use range 4-25 between 4°F and 25°F if manufacturer's specification is not available) ` System passes if actual superheat is within the allowable superheat range PASS - Enter Pass or Fail n D +, 0 Reg: 213-A0026057A-M2500001A-0000 Registration Date/Time: 2013/05/07 17:55:12 HERS'Provider: CalCERTS, Inc. 2008 Residential Compliance'Forms March 2013 t INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 6 of 6) Site Address: Enforcement Agency: Permit Number: 56-635 Riviera, La Quinta CA 92253 City of La Quinta 13-560 Standard Charge Measurement Summary: System shall pass both refrigerant charge criteria, metering device criteria (if applicable), and minimum cooling coil airflow criteria based on measurements taken concurrently during system operation. If corrective actions were taken, all applicable verification criteria must be re -measured and/or recalculated. System Name or Identification/Tag System 1 CSLB License: 906115 Date Signed: 14/23/2013 position With Company (Title): System meets all refrigerant charge and Name of TPQCP (if applicable): Control Program (TPQCP)? ❑ Yes ❑ No airflow requirements. PASS Enter Pass or Fail ® Residential Appendix RA3.2.2 requires that if the outdoor temperature is between 55°F and 65°F the return air dry bulb temperature shall be maintained above 70°F during the Standard Charge Measurement Procedure. The signature of the Responsible Person in the declaration statement below certifies this requirement has been met for all applicable system verifications reported on this certificate. 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 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,groupabut not checked.by a HERS=rater;.an,d'if�those' installations faii,to meet;theirequirements of such quality assurance checking, the required corrective action and additional checking/testing of other installations in that HERS sample groupAwill be performed"at'my expense.' . I reviewed a copy of theflf4 ificate of Compliance (CF-1R),form approved'by the enforcement agency,that identifies the specific requirementssjfor the installation. I certify that the requirements detailed on the CF-1Rthat,apply•t$the-,,,-,, installation have been met. �. � i 4� I .. . I will ensure' thFat a`completed; signed copy oftthis Installation Certificate J 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 alternatives, and beginning October 1, 2010, for all low-rise residential buildings. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) CERTIFIED COMFORT SYSTEMS INC Responsible Person's Name: Responsible Person's Signature: Mark Hyde Mark Hyde CSLB License: 906115 Date Signed: 14/23/2013 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-A0026057A-M2500001A-0000 Registration Date/Time: 2013/05/07 17:55:12 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2013