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MECH (13-0055)77569 Avenida Madrugada 13-0055 P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 13-00000055 Property Address: 77569 AVENIDA MADRUGADA APN: 773-340-020-20 -14496 Application description: MECHANICAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 6850 S VOICE (760) 777-7012 FAX (760) 777-7011 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 1/17/13 Owner: SALLY LOWE 77569 AVENIDA MADRUGADA LA QUINTA, CA 92253 Contractor: Applicant: Architect or Engineer: HYDES 42949 MADIO STREET INDIO, CA 92201. It(k (760)360-2202 ^> ( Lic. No.: 906115 LICENSED CONTRACTOR'S DECLARATION 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 3C36 Licen o.: 906115 '.D/ / 7 f onti cfdr:Ae 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 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 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 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 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 D JAN 17 2013 L OF LA 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 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and Will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued.. My workers' compensation insurance carrier and policy number are: Carrier 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 subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forth ' h corp with those provisions. Da 3. Applicant/ 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 count to enter upon the above-mentioned property for :;;p rposes. = -i' )X D te: Signature (Applicant or Agentl: Application Number . . . . . 13-00000055 Permit MECHANICAL Additional desc . Permit Fee . . . . 40.50 Plan Check Fee 10.13 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 7/16/13 Qty Unit Charge Per Extension BASE FEE 15.00. 1.00 9.0000 EA MECH B/C <=3HP/100K BTU 9.00 1.00 16.'5000 EA MECH B/C >3-15HP/>100K-500KBTU 16.50 ---------------------------------------------------------------------------- Special Notes and Comments HVAC 5 TON 13 SEER FURNACE, INDOOR COIL, CONDENSING UNIT CHANGE OUT. 2010 CODES ---------------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 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 # Permit # Project Address: 7 7 A. P. Number: Contractor: v e - 6 ',N F I Address: City, ST, Zip: Telephone: ✓2 Stat L" City Of La Quinta Building & Safety Division P.O. Box 1504, 78-495 Calle Tampito La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet L / IG, 04 Owner's Name: S OLv Address: City, ST, Zip: 5kri 5 !i. /t.'. Telephone: `OZ Ic> Project Description: e tc. # City 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 ,e-ei-- Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair' p Demo Ft.: #Stories: # Units: ===Sq. Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE 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 2" Review, ready for correciionsrissue Electrical Called Contact Person Plumbing Plans picked up S.M.I. Plans resubmitted Grading '"' Review, ready for corrections/issue Developer Impact Fee Called Contact Person A-I.P.P. Date of permit issue Total Permit Fees Ci Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-lR-ALT-HVAC Climate Zones 10 - 15 Site Address: Enforcement Agency: Date: Permit #: 77-569 Avenida Madrugada La Quinta, CA 92253 City of La Qui nta ]an 16, 2013 Equipment Typel List Minimum Efficiency2 Duct insulation requirement Conditioned Floor Area Thermostat ❑ Package Unit ® Furnace ® Indoor Coil ® AFUE 78% ® SEER0 13• ❑ COP ❑ HSPF ❑ R 6 (CZ 10-13) Served by system ® Setback not already present, must be ® Condensing Unit [3 EER E3 Resistance [3in R 8 (CZ 14-15) 2000 sf installed) [3 Other 1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF-IR-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-611 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-111 and CF-611 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-4R 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. The system-will not be Ducted (ie_Ductless,Mini-Split System,)•(Also Exempt fromRefrigerantryGharge) 112. New HVAC System Required Forms: (11rd `lits . Cut in or Changeout with; CF 6R'forms MECH-04, MECH=20 HERS, and °fors ` l # new ducts: (all new ( P Ystems) MECH-22 HERS and ductingdall new MECH=25'HERS f e ui ment 4, CF 4R forms: MECH-20, nd (for split systems) MECH=22 and MECH-25 ' For Split Systems: Duct leakage <,'6 percent; RC, CCA, 2: 350 CFM/ton, FWD,`TMAH, SIMS, and either HSPP or PSPP. For Packaged Units: Duct leaka9e < 6 percent ❑ 3. New Ducts with/or without Required Forms: Replacement . Includes replacing or installing all new ducting and/or outdoor condensing unit and/or indoor coil and/or furnace. No or some CF-611 forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS CF-411 forms: MECH-20 and (for split systems) MECH-25 equipment changed. For Split Systems: Duct leakage < 6 percent; RC, CCA >_ 300 CFM/ton, TMAH For Packaged Units: Duct 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 duct in unconditioned space. CF-4R forms: MECH-21 For split system or packaged units: Duct leakage < 15 percent ❑ EXCEPTION: Existing duct 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: ]an 16, 2013 Address: 42-949 MADIO STREET License: 906115 City/State/Zip: INDIO / CA / 92201 Phone: (760) 360-2202 Rcy: —1-HvvvJ147H-uuUuuuUUU-0000 Registration Date/Time: 2013/01/16 14:26:44 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms July 2010 INSTALLATION CERTIFICATE CF-6111-MECH-04 Space Conditioning Systems, Ducts and Fans (Page 1 of 2) Site Address: # of Identical Systems Efficiency (AFUE, etc.)1, 3 (>=CF -1R value)4 77-569 Avenida Madrugada, La Quinta CA 92253 (System Enforcement Agency: Permit Number: 1) City of La Quinta 13-55 Space Conditioning Systems Heating Equipment Equip Type (package- heat pump) CEC Certified Mfr. Name and Model Number ARI Reference Number2 # of Identical Systems 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 aud2c100a9601ab 1 80 AFUE Attic R-4.2 80 96 kBtu / c,00rnng equMent Equip Type (package heat pump) CEC Certified Mfr. Name and Model Number ARI Reference Number2 # of Identical Systems Efficiency (SEER and EER) 1, 3 (>=CF -1R value)4 Duct Location (attic, crawl- space, etc.) Duct R -value Cooling Load (kBtu/hr) Cooling Capacity (kBtu/hr) Split A/C " american standard ,1 4ttb3060d1000baJ)f .,-- - 113SEER^ 4 11r/EER ti L,--'- Attic j R-4.2 { 55 j 58 kBtu / 1. If project Is new construction, see Footnotes to Standards Table 151-B and Table 151-C for duct ceiling alternative compliance. 2. ARI Reference Number can be found by entering the equipment model number at http://www.aridirectory. org/ari/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 -IR is reference it is also applicable to the CF -1R, CF -IR -AA or CF -IR -ALT ALL BOXES MUST BE CHECKED TO BE A VALID FORM ® §110-§113: HVAC equipment is certified by the California Energy Commission. H §150(h): Heating and/or cooling loads calculated in accordance with ASHRAE, SMACNA, or ACCA. ® §150(i): Setback Thermostat on all applicable heating and/or cooling systems meet the requirements of §112(c). ® §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. Reg: 213-A0003145A-M0400001A-0000 Registration Date/Time: 2013/01/22 12:22:01 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-04 Space Conditioning Systems, Ducts and Fans (Page 2 of 2) Site Address: 77-569 Avenida Madrugada, La Quinta CA 92253 (System Enforcement Agency: Permit Number: 1) City of La Quinta 13-55 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. ❑ 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,inne r cores. 7 ; 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 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: 1/16/2013 Position With Company (Title): Reg: 213-A0003145A-M0400001A-0000 Registration Date/Time: 2013/01/22 12:22:01 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS Duct Leakage Test — Existing Duct System (Page i of 2) Site Address: ❑ 2. Measured leakage to outside less than 10% of Fan Flow 77-569 Avenida Madrugada, La Quinta CA 92253 (System Enforcement Agency: Permit Number: 1) City of La Quinta .13-55 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./' ✓ condenser in Tons f = ® Coolin` 9 Y s stem method: Size of 5 x 400 2000 CFM l A%1,11 b f ,,,,f ✓ 13 Heating system method: 21 Output Capacity in Thousands of Btu/hr =! 'CFM If ✓ 1 Y4., r ' ; ❑ Measured system airflow using,RA3.3 airflow -test procedures:" "CFM •• , j ,!'..r c` Option 1 used then: 1 Allowed leakage = Fan Airflow 2000 x 0.15 = 300 CFM Actual Leakage = 288 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 = CFM Pass if Actual leakage to outside is less than Allowed leakage QPass 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 El Fail 4j Reg: 213-A0003145A-M2100001A-0000 Registration Date/Time: 2013/01/22 12:20:22 HERS Provider: Ca10ERTS, 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: Responsible Person's Signature: Mark Hyde 77-569 Avenida Madrugada, La Quinta CA 92253 (System Enforcement Agency: Permit Number: 1) City of La Quinta 13-55 ® 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. "e ~-- gar—^. ® All supply and return register'600ts.must bel,sealed to the—ldry-wall if smoke test is utilized for;compliance — appliesto duct leakage compliance option 3 (leakage reduction by 60%) and option`41(fix all'accessible leaks) described above T /V # Ivities /® New ductinstallations,.cannot utilize, building aslplenums r,platforjm returns in lieu of ducts. ® 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, 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 -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 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: 1/16/2013 Position With Company (Title): Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? 0 Yes p No Reg: 213-A0003145A-M2100001A-0000 2008 Residential Compliance Forms Registration Date/Time: 2013/01/22 12:20:22 HERS Provider: CalCERTS, Inc. March 2010 INSTALLATION CERTIFICATE* CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page i of 5) Site Address: Enforcement Agency: Permit Number: 77-569 Avenida Madrugada, La Quinta CA 92253 City of La Quinta 13-55 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. STMS are only required for completely new or replacement space -conditioning systems that utilize prescriptive compliance method. TMAH - Access Holes in Suooly and Return Plenume of Air Mandlsar System Name or Identification/Tag System 1 System Location or Area Served I Whole House 1 ® Yes ❑ No 5/16 inch (8 mm) access hole upstream of evaporative coil in the return plenum and labeled according to Figure in Section RA3.2.2.2.2. 2 ® Yes ❑ No 5/16 inch (8 mm) access hole downstream of evaporative coil in the supply plenum and labeled according to Figure in Section RA3.2.2.2.2. Yes to 1 and 2 is a pass. Enter Pass or Faill ✓ ® Pass ✓ ❑ Fail STMS - Sensor on the Evaoorator Coil System Name or Identification/Tag f/ System 1 3 ❑ Yes p Nii The sensor is factory installed, or field installed according to manufacturer's 6 ❑ Yes • ❑ No specifications, or isfinstalled by methodi/specifications approved by,the Executive 'ix i J Director. t r j ., C E) I` The sensor wire is terminated with a standard mini plug suitable for connection to a 4 ❑ Yes ,a ❑ No lly ;' digital thermometer. The sensor mini plug is accessible to the installing technician and the HERS rater without changing the airflow through the condenser`coil 5 ❑ Yes ❑ No IThe sensor measures the saturation temperature of the coil within 1.3 degrees F Yes to 3, 4, and 5 is a pass. Enter N/A if STMS are not applicable. Otherwise enter Pass or Fail 7 ✓ ®N/A ✓ El Pass ✓ [3 Fail STMS - Sensor on the Condenser Coil System Name or Identification/Tag I System 1 The sensor is factory installed, or field installed according to manufacturer's 6 ❑ Yes • ❑ No specifications, or is installed by methods/specifications approved by the Executive Director. The sensor wire is terminated with a standard mini plug suitable for connection to a 7 ❑ Yes ❑ No digital thermometer. The sensor mini plug is accessible to the installing technician and the HERS rater without changing the airflow through the condenser coil 8 ❑ Yes ❑ No The sensor measures the saturation temperature of the coil within 1.3 degrees F Yes to 6, 7, and 8 is a pass. Enter N/A if STMS are not applicable. Otherwise enter Pass or Fail ✓ ® N/A ✓ ❑ Pass ✓ ❑ Fail G` Reg: 213-A0003145A-M2500001A-0000 Registration Date/Time: 2013/01/22 12:19:45 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 :NSTALLATION CERTIFICATE CF-6R-MECH-25-HER! tefrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5' Site Address: Enforcement Agency: Permit Number: 77-569 Avenida Madrugada, La Quinta CA 92253 City of La Quinta 13-55 Standard Charge Measurement Procedure (for use if outdoor air dry-bulb is above 55°F) Procedures for determining Refrigerant Charge using the Standard Charge Measurement Procedure are available in Reference 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 is 55°F or below, the installer must use the Alternate Charge Measurement Procedure. Space Conditioning Svstems System Name or Identification/Tag System i (must be re -calibrated monthly) Date of Thermocouple.,Calibration • 1/16/2013' f System Location or Area Served Whole House Outdoor Unit Serial # 12444t3kig -.- _ _. Outdoor Unit Make american standard Outdoor Unit Model 4ttb3060d1000ba Nominal Cooling Capacity Btu/hr 60000 Date of Verification 1/16/2013 Date of Refrigerant Gauge Calibration 1/16/2013 (must be re -calibrated monthly) Date of Thermocouple.,Calibration • 1/16/2013' f (must be re -calibrated monthly) 1'1 GOiul OY I C111u=1 OIYI C,. I .-r I . i ! .J1 ! / 1 System Name or Identifii:ation/Tag F W System 1 01 s f \ Supply (evaporator leaving),airdry-bulb ' t •- — -.- _ _. temperature (Tsupply, db) I Return (evaporator entering) air dry-bulb temperature (Treturn, db) Return (evaporator entering) air wet -bulb temperature (Treturn, wb) Evaporator saturation temperature 41 (Tevaporator, sat) Condensor saturation temperature 86 (Tcondensor, sat) Suction line temperature (Tsuction) 55 Liquid Line Temperature (Tliquid) 76 Condenser (entering) air dry-bulb 75 temperature (Tcondenser, db) Reg: 213-A0003145A-M2500001A-0000 Registration Date/Time: 2013/01/22 12:19:45 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-25-HER9 Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5) Site Address: Enforcement Agency: Permit Number: 77-569 Avenida Madrugada, La Quinta CA 92253 City of La Quinta 13-55 Minimum Airflow Reauirement 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, the value must be equal to or greater than the Calculated Minimum Airflow Requirement in the table below. Calculated Minimum Airflow Requirement (CFM) = Nominal Cooling Capacity (ton) X 300 (cfm/ton) System Name or Identification/Tag Fe f System 1 Calculated Minimum Airflow Requirement (CFM) 1S00 1 J; i • I Measured,Airfla! eing RA3,3 procedures (CFM). - 1725 Passes if measured airflow is greater than or equal to the calculated minimum airflow PASS requirement. Enter Pass or Fail Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for fixed orifice metering device systems System Name or Identification/Tag System 1 Calculate: Actual Superheat = Tsuction - Tevaporator, sat Target Superheat from Table RA3.2-2 using Treturn, wb and Tcondenser, db Calculate difference: Actual Superheat - Target Superheat = System passes if difference is between -5°F and +5°F Enter Pass or Fail 7 Reg: 213-A0003145A-M2500001A-0000 Registration Date/Time: 2013/01/22 12:19:45 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERE Refrigerant Charge Verification - Standard Measurement Procedure. (Page 4 of 5; Site Address: Enforcement Agency: Permit Number: 77-569 Avenida Madrugada, La Quinta CA 92253 City of La Quinta 13-55 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 =- 10.0 Tcondenser, sat - Tliquid Target Subcooling specified by manufacturer 10 Calculate difference: 0 Actual Subcooling - Target Subcooling = System passes if difference is between -3°F and +3°F PASS r I f` r 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 System 1 Calculate: Actual Superheat = 14.0 Tsuction - Tevaporator, 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 . f` PASSE r I f` r ,,,,Enter Pass or Fail f ,/ • , Reg: 213-A0003145A-M2500001A-0000 Registration Date/Time: 2013/01/22 12:19:45 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5) Site Address: Enforcement Agency: Permit Number: 77-569 Avenida Madrugada, La Quinta CA 92253 City of La Quinta 13-55 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 r Date Signed: 1/16/2013 Position With Company (Title): System meets all refrigerant charge and airflow Name of TPQCP (if applicable): Control Program (TPQCP)? 0 Yes p No requirements. PASS Enter Pass or Fail '1 DECLARATION i } 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 -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. I will ensure that all Installation Certificates will come from a HERS provider data registry for multiple orientation alternatives. and beainnina Ortnher 1. 201 n. fnr All lnw-rlcP rPclriantini hnilAinnc 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: 1/16/2013 Position With Company (Title): Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? 0 Yes p No Reg: 213-A0003145A-M2500001A-0000 Registration Date/Time: 2013/01/22 12:19:45 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-21 Duct Leakage Test — Existing Duct System (Page 1 of 2) Site Address: 77-569 Avenida Madrugada, La Quinta CA 92253 (System Enforcement Agency: Permit Number: 1) City of La Quinta 13-55 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 - existina duct system Select one compliance method from the following four choices. [:11. 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 Tons x 400 = _ CFM ✓ ❑ Heating system method: 21.7r x _ Output Capacity in Thousands of Btu/hr = _ CFM J ✓ ❑ Measured system airflow using RA3.3 airflow test procedures: _ CFM _ Option 1 used then: 1 Allowed leakage = Fan Flow _ x 0.15 = _ CFM Actual Leakage = _ 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 reductionCFM ((Leakage reduction_/ Initial leakage x 100% _ %oReduction 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-A0003145A-M2100001A-M21A Registration Date/Time: 2013/02/06 13:09:51 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: 77-569 Avenida Madrugada, La Quinta CA 92253 (System Enforcement Agency: Permit Number: 1) City of La Quinta 13-55 ❑ 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 Supp yland return register boots must be sealed to the drywall if., smoke.test'is utilized for, compliance — applies"to duct leakage compliance option 3 (leakage reduction by 60%) and option 4?(fix-all-``accessible leaks) described above: - 401 _1 : ...Yµy ❑ New duct installatlons.cannotsublize budding cavltles as plenurns,or platform returns in lieu of ducts:' " ❑ 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, 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 RAZ 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 -1R) 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) CERTIFIED COMFORT SYSTEMS INC Responsible Person's Name: CSLB License: Mark Hyde 1906115 HERS Provider Data Registry Information Sample Group # (if applicable): 384929 ❑ tested/verified dwelling ® not-tested/verified dwelling in la HERS sample group HERS Rater Information Ca10ERTS Certificate # CC1-1798723387 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: 1/24/2013 CC2005602 Reg: 213-A0003145A-M2100001A-M21A Registration Date/Time: 2013/02/06 13:09:51 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 5) Site Address: Enforcement Agency: Permit Number: 77-569 Avenida Madrugada, La Quinta CA 92253 City of La Quinta 13-55 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. 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 1 ❑Yes [INo 5/16 inch (8 mm) access hole upstream of evaporative coil in the return plenum and labeled according to Figure in Section RA3.2.2.2.2. 2 [3 Yes ❑ No 1 5/16 inch (8 mm) access hole downstream of evaporative coil in the supply plenum and labeled according to Figure in Section RA3.2.2.2.2. Yes to land 2 is a pass. Enter Pass or Faill ✓ ❑ Pass ✓ ❑ Fail STMS - Sensor •on the. Evaporator' Coil System Name'or Identification/Tag j ,/ . O, 3 (01 Yes ,• ❑ No The sensor is factory installed, orfield'installed according to manufacturer.'s specifications, or isoinstalled by method`s/specifications approved by the Executive ❑ Yes ; . specifications, or is installed by methods/specifications approved by the Executive Director.-- Director. -t t ioorj The sensor wire is terminated with a standard mini plug suitable for connection;to a{ 4 ❑Yes R ° UN o digital'thermometer.-The sens& mini plug is accessible to theiinstalling; echnician and the HERS rater without changing the airflow through the condenser coil and the HERS rater without changing the airflow through the condenser coil 5 Yes--- ❑ No When attached to a digital thermometer, the sensor provides an indication of the T❑ saturation temperature of the coil. saturation temperature of the coil. Yes to 3, 4, and 5 is a pass. Enter N/A if STMS are not applicable. Otherwise enter Pass or Fail ✓ [3 N/A ✓ [3 Pass ✓ ❑Fail STMS - Sensor on the Condenser Coil System Name or Identification/Tag I System i The sensor is factory installed, or field installed according to manufacturer's 6 ❑ Yes ❑ No specifications, or is installed by methods/specifications approved by the Executive Director. The sensor wire is terminated with a standard mini plug suitable for connection to a 7 ❑ Yes ❑ No digital thermometer. The sensor mini plug is accessible to the installing technician and the HERS rater without changing the airflow through the condenser coil 8 ❑ Yes ❑ No When attached to a digital thermometer, the sensor provides an indication of the saturation temperature of the coil. Yes to 6, 7, and 8 is a pass. Enter N/A if STMS are not ✓ ® N/A ✓ ❑ Pass ✓ ❑ Fail applicable. Otherwise enter Pass or Fail Reg: 213-A0003145A-M2500001A-M25A Registration Date/Time: 2013/02/06 13:11:57 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5) Site Address: Enforcement Agency: Permit Number: 77-569 Avenida Madrugada, La Quinta CA 92253 1 City of La Quinta 13-55 Standard Charge Measurement Procedure (for use if outdoor air dry-bulb is above SS°F) 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 is 55°F or below, the installer must use the Alternate Charge Measurement Procedure. Space Conditionino Svstems System Name or Identification/Tag System 1 (must be re -calibrated monthly) Date of Thermocouple:'Calibration i System Location or Area Served Whole House Outdoor Unit Serial # - Outdoor Unit Make Outdoor Unit Model Nominal Cooling Capacity Btu/hr Date of Verification .. oy.waaw anaa unwnaa Date of Refrigerant Gauge Calibrations (must be re -calibrated monthly) Date of Thermocouple:'Calibration i . ,(must be + re- ca"librated monthly) —,,System'1 System Name or Identificat onR g ' —,,System'1 Supply (evaporator leavin p 9)`air dry-bulb ry - temperature (Tsupply, db) Return (evaporator"entering) air dry-bulb temperature (Treturn; db) i Return (evaporator entering) air wet -bulb temperature (Treturn, wb) Evaporator saturation temperature. (Tevaporator, sat) Condensor saturation temperature (Tcondensor, sat) Suction line temperature (Tsuction) Liquid Line Temperature (Tliquid) Condenser (entering) air dry-bulb temperature (Tcondenser, db) Reg: 213-A0003145A-M2500001A-M25A Registration Date/Time: 2013/02/06 13:11:57 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-411-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5) Site Address: Enforcement Agency: Permit Number: 77-569 Avenida Madrugada, La Quinta CA 92253 City of La Quinta 13-55 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. Calculated Minimum Airflow Requirement (CFM) = Nominal Cooling Capacity (ton) X 300 (cfm/ton) 1 System Name or Ideritification/Tag, t 17 T-1711\` ,r` Calculatfeld Minimum Airfllooww Requir r ent (CFM) e /1-4 Measured Airflow usin RA3 Y' rocedures CFM Passes if measured airflow is greater than or equal -' to the calculated minimum airflow requirement. ^ Enter Pass or Fail Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for fixed orifice metering device systems System Name or Identification/Tag Calculate: Actual Superheat = Tsuction - Tevaporator, sat Target Superheat from Table RA3.2-2 using Treturn, wb and Tcondenser, db Calculate difference: Actual Superheat - Target Superheat = System passes if difference is between -6°F and +6°F Enter Pass or Fail Reg: 213-A0003145A-M2500001A-M25A Registration Date/Time: 2013/02/06 13:11:57 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure . (Page 4 of 5) Site Address: Enforcement Agency: Permit Number: 77-569 Avenida Madrugada, La Quinta CA 92253 City of La Quinta 13-55 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 Calculate: Actual Subcooling = Tcondenser, sat - Tliquid Target Subcooling specified by manufacturer Calculate difference: Actual Subcooling - Target Subcooling = System passes if difference is between -4°F and +4°F Enter Pass or Fail " • - - _ Metering Device Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag Calculate: Actual Superheat.= i Tsuction - Tevaporator, sat Enter allowable superheat range from manufacturer's specifications (or use range between 3°F and 26°F if manufactur'er's specification is not,a.vailable) System passes°if actual superheat is'within^the allowable superheat range 7x ,r•FEnter Pass or Fail " • - - _ Reg: 213-A0003145A-M2500001A-M25A Registration Date/Time: 2013/02/06 13:11:57 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-411-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5) Site Address: Enforcement Agency: Permit Number: 77-569 Avenida Madrugada, La Quinta CA 92253 City of La Quinta 13-55 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 1906115 HERS Provider Data Registry Information Sample Group # (if applicable): 384929 System meets all refrigerant charge and airflow ® not-tested/verified dwelling in a HERS sample group 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 Provider: Date Signed: 1/24/2013 CC2005602 f e, 3 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 aaencv. 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: CSLB License: Mark Hyde 1906115 HERS Provider Data Registry Information Sample Group # (if applicable): 384929 ❑ tested/verified dwelling ® not-tested/verified dwelling in a HERS sample group HERS Rater Information _CaICERTS Certificate # CC1-1798723387 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: 1/24/2013 CC2005602 Reg: 213-A0003145A-M2500001A-M25A Registration Date/Time: 2013/02/06 13:11:57 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010