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MECH (11-0498)54100 Avenida Madero 11-0498 P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 11-00000498 Property Address: 54100 AVENIDA MADERO APN: 774-193-005-20 -000000- Application description: MECHANICAL Property Zoning: COVE RESIDENTIAL Application valuation: 4000 Applicant: T4,Yl " BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Architect or Engineer: afA 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 License No.: 892080 ate: ntractor: 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).: (_) 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.). (_) 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. , B.&P.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: LQPER.MIT Owner: WELLS FARGO 54100 AVENIDA MADERO LA QUINTA; CA 92253 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 5/13/11 Contractor: D HVAC PROFESSIONAL SERVIC. Ii 31160 SIERRA DEL SOL t°I I } 3 211 THOUSAND PALMS, CA 92276 (760)272-4237 Lic. No.: 892080 CITY OF LA QUINTA FINANCE 0; - :PT. - 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 EX MPT Policy Number EXEMPT 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 forthwith comply with those provisions. i+Qe: plicant: 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 andcounty ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upon th :above-mentioned property for inspection purposes. - Plate: S' ature (Applicant or Agent): Application Number . . . 11-00000498 Permit . . . MECHANICAL Additional desc . Permit Fee . . . . 40.50 Plan Check Fee 10.13 issue Date . . . . Valuation 0 Expiration Date 11%09/11 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 9.0000 EA MECH FURNACE <=100K 9.00 1.00 16.5000 EA MECH B/C >3-15HP/>100K-500KBTU 16.50 ---------------------------------------------------------------------------- Special Notes and Comments INSTALL NEW FURNACE; INDOOR COIL, CONDENSER (13 SEER). 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 Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -1R -ALT -HVAC Climate Zones 10 to 15 Site A dilress7 E orcernent A en g Date: Permit #: G //- X98 Equipment T List Minimum Efficiency' Duct insulation requirement Conditioned Floor Area Thermostat ❑ ackaged Unit WJ Furnace ❑ AFUE ❑ COP Over 40 ft of ducts added or ❑ Setback W. Indoor Coil econdensing 9l`SEER`j: ;1(.v7 ❑ HSPF replaced in unconditioned space OR Served by system afnot already Unit ❑ EER ❑ Resistance 6 (CZ 10-13) sf present, must be ❑ Other ❑ R 8 (CZ 14-15) installed) 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 EL&Jendes: 13 SEER, 78%AFUE. 7.7HSPFfortypical 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 be left shall 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 CFAR forts (no hand filled CF-4Rs allowed) are filled out and si ed. B !9nning October 1, 2010 a registered copy of the CF -1R and CF -6R Mall also be on site for final inspection. 1. HVAC Changeout Required Forms: • AII.HVAC Equipment replaced CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH- 25 -HERS CF -4R forms: MECH- 21 and fors lits stems MECH-25 • Condenser Coil and/or • Indoor Coil and /or CF -6R forms: 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 For Packaged Units: Duct leakage < 15 percent Exempted from duct leakage testing if: 0:1 - 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 ❑ 2. New HVAC System Required Forms: • Cut in or Changcout with new CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and CH -25 -HERS ducts: (all new ducting and all ME new equipment) CF -4R fors: MECH 20-, and (for split systems)MECH-22,.and MECH 25 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 Replacement Required Forms: • Includes replacing or installing all new ducting CF -6R fors: MECH-04, MECH-20-HERS,and (for split systems) MECH-25-HERS and/or outdoor condensing unit and/or indoor CF -4R forms: MECH-20 and (for split systems) MECH-25 coil and/or furnace. Not all 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 I Required Forms: • Includes adding or replacing more than linear feet of duct in unconditioned space. CF -6R forms: MECH-04, MECH-2I-HERS 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) • 1 certify that this Certificate of Compliance documentation is accurate and complete. • 1 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 I 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 tans and specifications submitted to the enforcement agency for approval with thePer.m it application, Name:. •, \ 1 U 1Date: Signature:Company: 5- )3-- Zd i Address:3 I 1 10 0 i',e YVC, 6C( p \ License: CJ Zd 6 City/State/Zip: v . - Z Z% Phone: j -t Z ? 2 ZUU6 Kestaential Compliance Forms March 2010 Bin # City of La Qurnta Building & Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # Q, (J J Project Address: Owner's Name: A. P. Number: Address: Legal Description: Contractor: v FT r0 'e 5 5 1 c ry 14'\ _ )v City, ST, Zip: Telephone: 46 O —C19 - 7611 Project Description: Address: ( e Y I --G` ` ( City, ST, Zip: L1 l v,, -D- Telephone: 76(j.-27Z.--L Z ' ,i.;;;.. :w f;..n::: •f :, ..;.<;.. ryCity Lie. #.: State Lie. # : Z(f Arch., Engr., Designer: Address: City., ST, Zip: Telephone: ... rn; :`:f '•:.:.vrt j'f'r v:$:fr. v;.y::'..' ` 4>«•:.ic'i• :K•v: .:: r; < •`•";'.;. 4y:: yy{wyyy{:. 'l". ':vll" i'•thiifp >.. O>\i •rye S f nigh%4%ifiih+`Lr K'. i;.f:! 5'ACvi ti• :{t::••rfr,.fk:;;w:.;:,., :f°<Eaif,{xh.: Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo State Lie. #: Name of Contact Person: Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: Estimated Value of Project: q0 0 Q APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cates. Reviewed, ready for corrections Plan Check Deposit Truss Cates. Called Contact Person Plan Check Balance Title 24 Cates. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2°" Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- '`" Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees ,r Total Permit Fees INSTALLATION CERTIFICATE CF-6R-MECH-0 Space Conditioning Systems, Ducts and Fans (Page 1 of 2) Site Address: 54-100 Avenida Madero, La Quinta CA 92253 (System Enforcement Agency: Permit Number: 1) City of La Quinta 11-498 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 Heat Pump Heil N4H342GKE100 1 7.7 HSPF Attic R-4.2 42.0 3.5 Tons Type and EER) (attic, (package ARI, # of 1, 3 crawl- Cooling Cooling heat pump) CEC Certified Mfr. Name and Model Number Reference Number2 Identical Systems (>=CF -1R value)4 space, etc.) Dud R -value Load (kBtu/hr) Capacity (kBtu/hr) 1 Heil FEM4X4800A1 , 1 13.0 SEER,, 10.J0/EER \ //_ Attic j I R-4.2 - , 37.81; 3.5 Tons I Jj} Cooling Equipment 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 -IR form. 4. When CF -1R 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 0 §110-§113: HVAC equipment is certified by the California Energy Commission. 0 §150(h): Heating and/or cooling loads calculated in accordance with ASHRAE, SMACNA, or ACCA. 0 §150(i): Setback Thermostat on all applicable heating and/or cooling systems meet the requirements of §112(c). 0 §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. 0 Reg: 211-A0025755A-M0400001A-0000 Registration Date/Time: 2011/05/27 17:43:40 HERS Provider: CalCERT3, Inc. 2008 Residential Compliance Forms August 2009 Efficiency Dud Equip (SEER Location Type and EER) (attic, (package ARI, # of 1, 3 crawl- Cooling Cooling heat pump) CEC Certified Mfr. Name and Model Number Reference Number2 Identical Systems (>=CF -1R value)4 space, etc.) Dud R -value Load (kBtu/hr) Capacity (kBtu/hr) Split Heat Pump Heil FEM4X4800A1 , 1 13.0 SEER,, 10.J0/EER \ //_ Attic j I R-4.2 - , 37.81; 3.5 Tons I Jj} Jar A_ C , C'r . ,11 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 -IR form. 4. When CF -1R 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 0 §110-§113: HVAC equipment is certified by the California Energy Commission. 0 §150(h): Heating and/or cooling loads calculated in accordance with ASHRAE, SMACNA, or ACCA. 0 §150(i): Setback Thermostat on all applicable heating and/or cooling systems meet the requirements of §112(c). 0 §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. 0 Reg: 211-A0025755A-M0400001A-0000 Registration Date/Time: 2011/05/27 17:43:40 HERS Provider: CalCERT3, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-0 Space Conditioning Systems, Ducts and Fans (Page 2 of 2) Site Address: 54-100 Avenida Madero, La Quinta CA 92253 (System Enforcement Agency: Permit Number: 1) City of La Quinta 11-498 Ducts and Fans §150(m): Duct and Fans M 1. All air -distribution system duds 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 duds 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 dud -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 0 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. Duds installed in cavities and support platforms shall not be compressed to cause reductions in the cross-sectional area of the ducts. 0 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. 0 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. 8 10. Flexible ducts cannot have porous,i 4nerycores... 1-T 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 -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. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) HVAC PROFESSIONAL SERVICE Responsible Person's Name: Responsible Person's Signature: Jose Trujillo Jose Trujillo CSLB License: 892080 Date Signed: 5/16/2011 Position With Company (Title): Reg: 211-A0025755A-M0400001A-0000 Registration Date/Time: 2011/05/27 17:43:40 HERS Provider: CalCERTS, 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: 54-100 Avenida Madero, La Quinta CA 92253 (System Enforcement Agency: Permit Number: 1) City of La Quinta 11-498 ❑ 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.)_ =nter the Duct System Name or Identification/Tag: System 1 =nter the Duct System Location or Area Served: Whole House Vote: Submit one Installation Certificate for each duct system that must demonstrate compliance in the swelling. This installation certificate is required for compliance for alterations and additions in existing dwellings to space conditioning systems and duct systems. Vote: For existing dwellings, a completely new or replacement duct system can also include existing parts of he original duct system (e.g., register boots, air handler, coil, plenums, etc.) if those parts are accessible ind they can be sealed. For a completely new or replacement duct system installed in an existing dwelling, ise the Installation Certificate titled "Duct Leakage Test - Completely New or Replacement Duct System. " Duct Leakage Diaanostic Test - existina duct system Select one compliance method from the following four choices. M 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.)_ Determiner nominal Fan Flow using one of the following three calculation methods./ ,r 1 ✓ 0 Cooling system method: Size of condenser in Tons 13.5 x'400 = 1400 CFM'' ✓ ! r ,' r -4 1 / t 21 ❑ Heating system method: .7 x Output Capacity in Thousands of Btu/hr = CFM l , 1 l / r ✓ / i ; ❑ Measured system airflow using RA3.3 airflow test procedures: _ CFM / / Option 1 used then: 1 Allowed leakage = Fan Airflow 1400 x 0.15 = 210 CFM Actual Leakage 68 CFM Pass if Actual Leakage is less than Allowed leakage M 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 Pass El Fail Option 3 used then: Initial leakage prior to start of work = _ CFM Final leakage after sealing all accessible leaks using smoke test = CFM 3 Initial leakage _ - Final leakage _ = Leakage reduction_CFM ((Leakage reduction _ / Initial leakage _) x 100% _ Reduction Pass if % Reduction > 60% Pass Fail Option 4 used then: 4 All accessible leaks repaired using smoke test. HERS rater must verify (No Sampling). Pass if all accessible leaks have been repaired using smoke Pass Fail Reg: 211-A0025755A-M2100001A-0000 Registration Date/Time: 2011/05/27 17:44:434 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 7 r INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS Duct Leakage Test - Existing Duct System (Page 2 of 2) Site Address: 54-100 Avenida Madero, La Quinta CA 92253 (System Enforcement Agency: Permit Number: 1) City of La Quinta 11-498 B 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. B All supply 11return register'boots - applies to duct leakage compliance leaks) described abovej .r" B New duct installations cannot utiliz •_ 411 ! 11( 'If . B Mastic and draw bands must be us leaks at all new duct connections DECLARATION STATEMENT must be sealed to the drywall if smoke test is utilized for compliance option 3 (leakage duction by 60%) and option 4;(fix all accessible y e building cavities as plenums,or platform returns in lieu of ducts ' ed in combination with cloth backed rubber adhesive duct'tape to seal • 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 -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 buildings. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) HVAC PROFESSIONAL SERVICE Responsible Person's Name: Responsible Person's Signature: Jose Trujillo Jose Trujillo CSLB License: Date Signed: Position With Company (Title): 892080 5/16/2011 rIsthiris installation monitored by a Third Party Quality Name of TPQCP (if applicable): ol Program (TPQCP)? ❑ Yes Q No Reg: 211-A0025755A-M2100001A-0000 2008 Residential Compliance Forms Registration Date/Time: 2011/05/27 17:44:43 HERS Provider: CalCERTS, Inc. March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-21 Duct Leakage Test — Existing Duct System (Page 1 of 2) Site Address: 54-100 Avenida Madero, La Quinta CA 92253 (System Enforcement Agency: Permit Number: 1) City of La Quinta 11-498 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. © 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.), r r Determine tnominal Fan Flow using one ofAhe following three calculation methods.,9' U ✓ 0 Cooling system method:: Size oficondenser in Tons 1 3.5 x 400 = 1400 CFM r %0'0 Heatingsystem method: 21.7 x _ Output Capacity y p p ty in Thousands of Btu/hr = CFM ? ) ✓ ❑ Measured system airflow usingRA3.3 airflow test procedures: ' CFM / _ Option i used then: 1 Allowed leakage = Fan Flow 1400 x 0.15 = 210 CFM Actual Leakage = 68 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 0 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. HERS rater must verify (No sampling). No smoke allowed to leak from system. Including ducts, plenums, air handler and door panel. Pass if all accessible leaks have been repaired using smoke Pass Fail 41 Reg: 211-A0025755A-M2100001A-M21A Registration Date/Time: 2011/05/27 17:54:03 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-21 Duct Leakage Test - Existing Duct System (Page 2 of 2) Site Address: 54-100 Avenida Madero, La Quinta CA 92253 (System Enforcement Agency: Permit Number: 1) —1 City of La Quinta 11-498 © 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. 9 All supply an n register`boots'mus sealed drywa s oke test is utilized f compliance - applies'to duct leakage compliance option 3 (leakage reduction by 60%) and option 4 (fix all accessible leaks) described above `' ; '? C © New duct installations cannot utilize building cavities as plenums or platform returns in lieu of ducts. 1 All 0 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 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) of Compliance (CF -1R) 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) HVAC PROFESSIONAL SERVICE Responsible Person's Name: CSLB License: Jose Trujillo 1892080 HERS Provider Data Registry Information Sample Group # (if applicable): N/A tested/verified dwelling ❑ not-tested/verified dwelling in la HERS sample group HERS Rater Information CalCERTS Certificate # CCI -1798564128 HERS Rater Company Name: Energy Management Services Responsible Rater's Name: Responsible Rater's Signature: Jack B LaFontaine Jack B LaFontaine Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 5/27/2011 CC2004051 Reg: 211-A0025755A-M2100001A-M21A Registration Date/Time: 2011/05/27 17:54:03 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 W Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -IR -ALT -HVAC Climate Zones 10 - 15 Site Address: Enforcement Agency: Date: Permit #: 54-100 Avenida Madero La Quinta, CA 92253 City of La Quinta May 27, 2011 Duct insulation Conditioned Floor Equipment Type1 List Minimum Efficiency2 requirement Area Thermostat ❑ Package Unit Furnace C] Indoor Coil ❑ AFUE 0 SEER 13.0 ❑ COP 0 HSPF 7,7 ❑ R 6 (CZ 10-13) ❑ R 8 Served by system 1390 sf © Setback If not already present, must be p Condensing Unit ❑ EER ❑ Resistance (CZ 14-15) installed) O 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, 7801o. 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. D 1. HVAC Changeout Required Forms: . All HVAC Equipment CF -611 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 5 300 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 from_ Refrigerant Charge) ❑ 2. New HVAC System Required Forms: . Cut in'or Changeout with' new ducts: (all new /f r ! f CF -6R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-22-HERS, and MECH-25-HERS ducting 10A all new f f ] CF -4R forms: MECH 20, and (for split systems) MECH-22, and MECH 25 ' 1\ equipment) %f / -17 i / l / . l/- . . For Split Systems: Duct leakage < 6 percent; RC, CCA >_ 350 CFM/ton, FWD, TMAH, STMS, and either HSPP or PSPP. " For Packaged Units: Dud leakage < 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 CF -611 forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS coil and/or furnace. No or some equipment CF -4R forms: MECH-20 and (for split systems) MECH-25 changed. For Split Systems: Dud 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 -611 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 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: Jose Trujillo Signature: Jose Trujillo Company: HVAC PROFESSIONAL SERVICE Date: May 27, 2011 Address: 31160 SIERRA DEL SOL Licenser 892080 City/State/Zip: THOUSAND PALMS / CA / 92276 , Phone: (760) 272-4237 Reg: 211-A0025755A-00000000-0000 Registration Date/Time: 2011/05/27 17:27:56 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms July 2010 INSTALLATION CERTIFICATE* CF-611-MECH-25-HER: Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 5; Site Address: Enforcement Agency: Permit Number: 54-100 Avenida Madero, La Quinta CA 92253 1 City of La Quinta 11-498 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 Supply and Return Plenums of Air Handler System Name or Identification/Tag System 1 System Location or Area Served Whole House 1 p 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 p 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 Evaporator Coil System Name. or Identification/Tag5 ! System 1 l 1 \ /,,/ ' ) l 0 1 < ,. 3 (E] Yes E)'No' The sensor is factory installed, or,field installed according to manufacturer's specifications, or is'installed by methods/specifications approved by the Executive Director. 4 ❑ Yes ❑ No" The sensor wire is terminated with a standard mini plug suitable for connection to a digital thermometer. The sensor mini plug is accessible to the installing technician_ and the HERS rater without changing the airflow through the condenser` coil' ❑ Yes ❑ No The sensor measures the saturation temperature of the coil within 1.3 degrees F Y e;sto,34, and 5 is a pass. Enter N/A if STMS are not pplicable. Otherwise enter Pass or Fail -7 ✓ 8 N/A ✓ C] Pass ✓ E] 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 ✓ N/A ✓ El Pass ✓ El Fail applicable. Otherwise enter Pass or Fail Reg: 211-A0025755A-M2500001A-0000 Registration Date/Time: 2011/05/27 17:48:35 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5) Site Address: Enforcement Agency: Permit Number: 54-100 Avenida Madero, La Quinta CA 92253 City of La Quinta 11-498 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 Systems System Name or Identification/Tag System i (must be re -calibrated monthly) :. , Date of Thermocouple Calibration /' / r. , b 5/27/201 1. I System Location or Area Served Whole House l I Outdoor Unit Serial # E102416861 Outdoor Unit Make Heil Outdoor Unit Model N4H342GKE100 Nominal Cooling Capacity Btu/hr 42,000 Date of.Verification 5/27/2011 Calibration of Diagnostic Instruments Date of Refrigerant Gauge Calibration 5/27/2011 (must be re -calibrated monthly) :. , Date of Thermocouple Calibration /' / r. , b 5/27/201 1. I . must be re -calibrated monthly) ( l Measured TemDeratures`(OF) I! ' I ---f I I k r i! r 1 ! System Name or Identification/System M i 1 , t,•-, ,r rte r r . 71 r ( I Supply (evaporator leaving) air dry-bulb 54 temperature (Tsupply, db) Return (evaporator entering) air dry-bulb 73 temperature (Treturn, db) Return (evaporator entering) air wet -bulb 58.2 temperature (Treturn, wb) Evaporator saturation temperature 43.2 (Tevaporator, sat) Condensor saturation temperature 109 (Tcondensor, sat) Suction line temperature (Tsuction) 59.4 Liquid Line Temperature (Tliquid) 99.7 Condenser (entering) air dry-bulb temperature (Tcondenser, db) Reg: 211-A002575.5A-M2500001A-0000 Registration Date/Time: 2011/05/27 17:48:35 HERS Provider: CalCERT3, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5) Site Address: Enforcement Agency: Permit Number: 54-100 Avenida Madero, La Quinta CA 92253 1 City of La Quinta 11-498 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, 19 db - Tsupply, db Target Temperature Split from Table RA3.2-3 20.3 using Treturn, wb and Treturn, db Calculate difference: Actual Temperature Split - -1.3 Target Temperature Split = Passes if difference is between -3°F and +3°F or, upon remeasurement, if between -3°F and PASS -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 F System 1 ^ Y r Calculated Minimum Airflow Requirement (CFM) 1 I // I 1/ Measured Airflomi. ng RA3.3 procedures (CFM)t 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 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 0 Reg: 211-A0025755A-M2500001A-0000 Registration Date/Time: 2011/05/27 17:48:35 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 :NSTALLATION CERTIFICATE CF-6R-MECH-25-HER: tefrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5' Site Address: Enforcement Agency: Permit Number: 54-100 Avenida Madero, La Quinta CA 92253 1 City of La Quinta 11-498 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 = 9.3 Tcondenser, sat - Thquid Target Subcooling specified by manufacturer 10 Calculate difference: -0.7 Actual Subcooling - Target Subcooling = System passes if difference is between -3°F and +3°F PASS Enter Pass or Fail PASS ,• ' 1 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 = 16.2 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 ;r PASS ,• ' 1 Enter Pass or Fail f , Reg: 211-A0025755A-M2500001A-0000 Registration Date/Time: 2011/05/27 17:48:35 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: 54-100 Avenida Madero, La Quinta CA 92253 1 City of La Quinta 11-498 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: Date Signed: Position With Company (Title): System meets all refrigerant charge and airflow 5/16/2011 Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): requirements. PASS Enter Pass or Fail 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 buildings. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) HVAC PROFESSIONAL SERVICE Responsible Person's Name: Responsible Person's Signature: Jose Trujillo Jose Trujillo CSLB License: Date Signed: Position With Company (Title): 892080 5/16/2011 Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? ❑ Yes ❑ No Reg: 211-A0025755A-M2500001A-0000 Registration Date/Time: 2011/05/27 17:48:35 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms August 2009 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: 54-100 Avenida Madero, La Quinta CA 92253 City of La Quint a 11-498 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 Supply and Return Plenums of Air Handler System Name or Identification/Tag System 1 System Location or Area Served Whole House 1 MYes C]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 M 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 ✓ M Pass ✓ ❑Fail STMS - Sensor,on.the Evaporator Coil System Name or Identification/Tag) ' rr' System 1 j r The sensor is factory installed, or,field installed according to manufacturer's 3 ❑ Yes ❑ No specifications, or is installed by methods/specifications approved by the Executive / Director. ( J / r CI f I ?I The sensor wire is terminated with a standard mini plug suitable for connection to a 4 ❑ Yes ❑ No digital thermometer. The sensor mini plug is accessible to the installing technician L"' 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 saturation temperature of the coil. Yes to 3, 4, and 5 is a pass. Enter N/A if STMS are not ✓ M N/A ✓ ❑ Pass ✓ ❑ Fail applicable. Otherwise enter Pass or 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 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 M N/A ✓ ❑ Pass ✓ ❑ Fail applicable. Otherwise enter Pass or Fail M Reg: 211-A0025755A-M2500001A-M25A Registration Date/Time: 2011/05/27 17:58:14 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: 54-100 Avenida Madero, La Quinta CA 92253 City of La Quinta 11-498 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 Systems System Name or Identification/Tag System i (must be re -calibrated monthly) Date of Thermocouple, Calibration]+ 5/27/201 System Location or Area Served Whole House re Outdoor Unit Serial # E102416861 Outdoor Unit Make Heil Outdoor Unit Model N4H342GKE100 Nominal Cooling Capacity Btu/hr 42,000 Date of Verification 5/27/2011 Lanoration or magnostic instruments Date of Refrigerant Gauge Calibration 5/27/2011 (must be re -calibrated monthly) Date of Thermocouple, Calibration]+ 5/27/201 =must be calibrated monthly) re measured i emperatures t 7r i I, ' I •- l I I t System Name or Identificati 0 nfTgg System i Supply (evaporator leaving) air dry-bulb 54 temperature (Tsupply, db) Return (evaporator entering) air dry-bulb 73 temperature (Treturn, db) Return (evaporator entering) air wet -bulb 58.2 temperature (T return, wb) Evaporator saturation temperature 43.2 (Tevaporator, sat) Condensor saturation temperature 109 (Tcondensor, sat) Suction line temperature (Tsuction) 59.4 Liquid Line Temperature (Tliquid) 99.7 Condenser (entering) air dry-bulb temperature (Tcondenser, db) Reg: 211-A0025755A-M2500001A-M25A Registration Date/Time: 2011/05/27 17:58:14 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: 54-100 Avenida Madero, La Quinta CA 92253 City of La Quinta 11-498 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, 19 db - Tsupply,db Target Temperature Split from Table RA3.2-3 20.3 using Treturn, wb and Treturn, db Calculate difference: Actual Temperature Split - -1.3 Target Temperature Split = Passes if difference is between -4°F and +4°F or, upon remeasurement, if between -4°F and PASS -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 (dm/ton) System Name o Identification/Tag ] V J 4 yl k" J ! ! Calculated Minimum Airflow Requirement (CFM) C Measured Airflow -using RA3.3 procedures (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: 211-A0025755A-M2500001A-M25A Registration Date/Time: 2011/05/27 17:58:14 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 [NSTALLATION CERTIFICATE CF-4R-MECH-2! Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of Sj Site Address: Enforcement Agency: Permit Number: 54-100 Avenida Madero, La Quinta CA 92253 1 City of La Quint a 11-498 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 = g.3 Tcondenser, sat - Tliquid Target Subcooling specified by manufacturer 10. Calculate difference: -0.7 Actual Subcooling - Target Subcooling = System passes if difference is between -4°F and +4°F PASS > \ ' r ! r' Enter Pass or Fail 4 PASS i 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 i Calculate: Actual Superheat = 16.2 Tsuction - Tevaporator, sat Enter allowable superheat range from manufacturer's specifications (or use range 3-26 between 3°F and 26°F if manufacturer's specification is not available) System passes if actual superheat is within the > \ ' r ! r' allowable superheat range / / '' 4 PASS i / Enter Pass or Fail 1 -"f 1 , -,Z , ,Y ,/' Reg: 211-A0025755A-M2500001A-M25A Registration Date/Time: 2011/05/27 17:58:14 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5) Site Address: Enforcement Agency: Permit Number: 54-100 Avenida Madero, La Quinta CA 92253 City of La Quinta 11-498 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 1892080 HERS Provider Data Registry Information Sample Group # (if applicable): N/A System meets all refrigerant charge and airflow ❑ not-tested/verified dwelling in a HERS sample group requirements. PASS Energy Management Services Responsible Rater's Name: Responsible Rater's Signature: Enter Pass or Fail Jack B LaFontaine Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 5/27/2011 CC2004051 i FY 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 -111) approved by the local enforcement agency. P applicable O( ) 9 Y P O <information reported on a licable sections of the Installation Certificates (CF -6R), signed and submitted b the person(s) .: . ponsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -111) approved by the enforcement agencv. Builder or Installer information as shown on the Installation Certificate (CF -6111) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) HVAC PROFESSIONAL SERVICE Responsible Person's Name: CSLB License: Jose Trujillo 1892080 HERS Provider Data Registry Information Sample Group # (if applicable): N/A © tested/verified dwelling ❑ not-tested/verified dwelling in a HERS sample group HERS Rater Information CalCERTS Certificate # CCi-1798564128 HERS Rater Company Name: Energy Management Services Responsible Rater's Name: Responsible Rater's Signature: Jack B LaFontaine Jack B LaFontaine Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 5/27/2011 CC2004051 Reg: 211-A0025755A-M2500001A-M25A Registration Date/Time: 2011/05/27 17:58:14 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010