SFD (12-0556)50730 Mandarina
12-0556
4 P.O. BOX 1504 -
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
r _ •
Application Number: '--1 12-00000556—
Property
2-00000556'x'Property Address: 56730 MANDARINA
APN: 776-210-001- - -
Application description: DWELLING - SINGLE FAMILY DETACHED
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 289770
Applicant: Architect or Engineer:
--------------------------------------------------
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.
Lic -Class: B License 750957
Date: ntract.. r
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
(_ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
and who does the work himself or herself through his or her own employees, provided that the
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
one year of completion, the owner -builder will have the burden of proving that he or she did not build or
improve for the purpose of sale.). -
• (_ 1 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.).
(_ ) 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:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/24/12
Owner: f
CITRUS 18 GROUP, LLC
30-875 DATE PALM DRIVE, STE. C
CATHEDRAL CITY, CA 92234
IDiD
Contractor: ftC
2012GRA ENTERPRISE, INC.30875 DATE PALM DRIVE S
CATHEDRAL CITY, CA 92 34 CITY Or. LAC,1UINTA
(760) 969-1400 FiUAN.aE
Lic. No.: 750957
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
Kissued.
` 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 STATE FUND Policy Number 71922311
_ 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
700 o the LabVCodeshall forthwith comply pith those provisions.
te pplicant: AZt1/J/,f. /
k, T
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 con [ruction, and hereby authorize representatives
this county to enter u n the above-mentioned propertyy/{or i ruction,
purqosCs.
Dat - •gnature (Applicant or Agent):
Application Number .
. . . . 12-00000556
Permit . .
BUILDING PERMIT
Additional desc .
Permit Fee . . . .
1304.50
Plan Check Fee :
847.93
Issue Date
Valuation
289770
Expiration Date
li/20/12
Qty Unit Charge
Pet
Extension
BASE
FEE
639.50
190.00 3.5000
THOU BLDG
100,,001-500,000
665.00
Permit . . . MECHANICAL
Additional desc .
Permit Fee . .
118.00
Plan Check Fee
25.75 -
Issue Date . .
Valuation
0
Expiration Date
11/20/12
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
2.00 9.0000
EA MECH
FURNACE <=100K
18.00
.00 9,.0000
EA MECH
B/C <=3HP/100K BTU
.00
2.00 16.5000
EA MECH
B/C >3'-15HP/>100K-500KBTU
33.00
7.00 6.5000
EA MECH
VENT FAN
45.50
1.00 6.5000
EA MECH
EXHAUST HOOD
6.50
Permit ELEC-NEW RESIDENTIAL,
Additional desc ..
Permit Fee
139.89
Plan Check Fee
34.97
Issue Date
Valuation
0
Expiration Date
11/20/12
Qty Unit Charge
Per
Extension
BASE
FEE
15.00 .
3198.00 .0350
ELEC
NEW RES - 1 OR 2 FAMILY
111.93
648.00 0200
----------------------------------------------------------------------------
ELEC
GARAGE OR NON-RESIDENTIAL
12.96
Permit PLUMBING
Additional desc .
Permit Fee . . . .
211.50
Plan Check Fee
52.88
Issue Date . .
Valuation
0.
Expiration Date
11/20/12
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
22.00 6.0000
EA PLB FIXTURE
132.00
LQPERMIT
rte.
Application Number
12-00000556
Permit . . . PLUMBING
Qty Unit Charge
Per
Extension
1.00 15.0000
EA PLB BUILDING SEWER
15.00
2.00 7'.5000
EA PLB WATER HEATER/VENT
15.00
1.00 3.0000
EA. PLB WATER INST/ALT/REP
3.00
1.00 9.0000
EA PLB LAWN SPRINKLER SYSTEM
9.00
10.00 .7500
EA PLB GAS PIPE.>=5
7.50
1.00 15.0000
EA PLB GAS METER
15.00
Permit . . . GRADING PERMIT
Additional desc .
Permit Fee
15.00 Plan Check Fee
.00
Issue Date
Valuation
0
Expiration Date
11/20/12
Qty. Unit Charge
Per
Extension
BASE FEE
15.00
Special Notes and Comments
SFD - LOT 7, PLAN 2B,
3198 SF. PERMIT
DOES NOT INCLUDE POOL,
SPA, BLOCK WALLS
OR DRIVEWAY APPROACH.
EXISTING SLAB TO
2001 CODES. 2010 CODES.
--------------------
Other Fees . . . .
ART IN PUBLIC PLACES -RES
224.43
BLDG STDS ADMIN (SB1473)
11.00
ENERGY REVIEW FEE
84.79
GRADING PLAN CHECK FEE
.00
MULTI -SPECIES (MSHCP) FEE
1254.00
STRONG MOTION (SMI) - RES
28.98
Fee summary Charged Paid Credited
Due
Permit Fee Total
1788.89 .00 .00
1788.89
Plan Check Total
961.53 .00 .00
961.53
'Other Fee Total
1603.20 .00 .00
1603.20
Grand Total
4353.62 .00 .00
4353.62 ,
LQPERMIT
r
_ I
Riverside County Fire Department Fire Protection Planning Section
t
Riverside Office: 2300 Market St., Ste. 150, Riverside, CA 92501 Ph.,(951) 955-0777 Fax (951) 955.4886
Murrieta office: 39493 Los Alamos Rd., Ste A, Murrieta, CA 92563 Ph. (951) 600.6160 Fax (951) 600.6164
Palm Desert Office: 77-933 Las Montanas Rd., x 201 Palm Desert, CA 92211.4131 Ph. (760) 863.8886 (760)'863-7072
t
Fire Department Clearance/Release
Date:
Z
Q l QVIj rfl
Fax:
Tract/Parcel Map #:
Permit/Lot #: .S0 ' 726 610 Ma col l'ivic/
)
Job Site Address:
Final For Recordation-
Release For Building,Permit(s)
Shell Final Only (No Tenant)
Art,offd- Final For@ caacr SP+''t(Pt!
. .rv+
Building Plan Check Fees Paid
Building Plan Check Fees Not Paid
Other Fees
Fees Not Required
If you should have any questions, please contact the appropriate Riverside County Fire Protection
Planning office for further assistance.
).
Autho ing Signature For Release
Print. Name
Form C — Revised 10/3/2012
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-20
Duct Leakage Test - Completely New or Replacement Duct System (Page 1 of 2)
Site Address: Enforcement Agency: Permit Number:
50730 Mandarina, La Quinta CA 92247 (System 1) 7City of La Quinta 7
Enter the Duct System Name or Identification/Tag: System 1
Enter the Duct System Location or Area Served: Master
Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the dwelling.
This certificate is required for compliance for completely new duct systems installed in new dwelling construction, and also for
completely new or replacement duct systems in existing dwellings. 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.
r%■ 4 1 nimnnnatii Tact - rmmnlataly now nr ronlarramant Ahert avctPm
Enter a value for the Allowed Leakage (CFM) for the duct system leakage verification. The value entered must be the VLLDCS
criteria or one of the three calculated leakage rates described below.
Verified Low Leakage Ducts in Conditioned Space (VLLDCS) Compliance Credit. If compliance credit for verified
Allowed
low leakage ducts in conditioned space is shown in the special features section of the CF -111, the leakage to outside test
Leakage
method must be used to verify duct leakage (refer to RA3.1.4.3.4), and 25 CFM must be entered for Allowed Leakage.
(CFM)
Allowed leakage calculation — (select one calculation method from this section). Use 6% (leakage factor = 0.06) for
calculations. When utilizing Low Leakage Air Handler (LLAH) credit, the allowed duct leakage may be specified by the
CF -1R to be less than 6%, in which case the user-specified leakage rate must be used in the calculations below. For
example, if the user-specified leakage (specified as a percentage of fan airflow) is reported on the CF -1R as 3%, then
use aleakage factor of 0.03 in the calculations below.
❑ Cooling system method:
Nominal capacity of condenser in Tons x 400 x leakage factor = CFM
❑ Heating system method:
21.7 x Output Capacity in Thousands of Btu/hr x leakage factor = CFM
❑ Measured airflow method (RA3.3):
Enter measured fan flow in CFM here x leakage factor = CFM
Enter value for Actual leakage (CFM) in the right column, from measurement using applicable duct leakage
Actual
Leakage
pressurization test procedure from Reference Residential Appendix RA3.1(CFM @ 25 Pa).
(CFM)
List Actual Leakage from duct leakage test(CFM)
Pass if Actual Leakage is less than Allowed Leakage ❑ Pass ❑ Fail
For complete replacement of duct systems only, if the 6 percent leakage rate criteria cannot be met, a smoke test
should be performed to verify that the excess leakage is coming only from a pre-existing furnace cabinet (air handler
cabinet), and not from otheraccessible portions of the duct system. A HERS rater must verify the installation (No
sampling allowed).
List Actual Leakage from smoke test(CFM)
Pass if all accessible leaks (except for existing air handler) are_sealed using smoke ❑ pass ❑Fail
Reg: 212-N0035872A-M2000073A-M20A Registration Date/Time: HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms August 2009
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-20
Duct Leakage Test - Completely New or Replacement Duct System (Page 2 of 23
Site Address: Enforcement Agency: Permit Number:
50730 Mandarina, La Quinta CA 92247 (System 1) City of La Quinta 7
POutside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off during duct leakage
esting. CFI OA ducts that utilize controlled motorized dampers, that open only when OA ventilation is required to meet ASHRAE
Standard 62.2, and close when OA ventilation is not required, may be configured to the closed position during duct leakage testing.
All supply and return register boots must be sealed to the drywall
0 New duct installations cannot utilize building cavities as plenums or platform returns in lieu of ducts.
0 Mastic and draw bands must be used in combination with Cloth backed, rubber adhesive duct tape to seal leaks at 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 -SR) 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 soecified on the Certificatek) of Comnlianrp (rF-1 R) annrnvpd by the PnfnrrPmPnt an—ry
Builder or Installer information as shown on the Installation Certificate (CF -6R)
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
GHA Companies
Responsible Person's Name:
Rudy Herrera
CSLB License:
N/A
HERS Provider Data Registry Information
Sample Group # (if applicable): 331028
tested/verified dwelling
Fi
® not-tested/verified dwelling in a
HERS sample group
HERS Rater Information Ca10ERTS Certificate #;CCI -1798671609
HERS Rater Company Name:
Responsible Rater's Name:
Tom Bachus
Responsible Rater's Signature:
Tom Buchus
Responsible Rater's Certification Number w/ this HERS Provider:
CC2005932
Date Signed: 11/7/2012
Reg: 212-N0035872A-M2000073A-M20A Registration Date/Time: HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms August 2009
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-20
Duct Leakage Test - Completely New or Replacement Duct System (Page 1 of 2)
Site Address: Enforcement Agency: Permit Number:
50730 Mandarina, La Quinta CA 92247 (System 2) City of La Quinta 7
Enter the Duct System Name or Identification/Tag: System 2
Enter the Duct System Location or Area Served: Great Room
Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the dwelling.
This certificate is required for compliance for completely new duct systems installed in new dwelling construction, and also for
completely new or replacement duct systems in existing dwellings. 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.
neirt 1 aalrana ninnnnctir Tact - vmmnlatalu naw nr ranlnramant dart cvctpm
Enter a value for the Allowed Leakage (CFM) for the duct system leakage verification. The value entered must be the VLLDCS
criteria or one of the three calculated leakage rates described below.
Verified Low Leakage Ducts in Conditioned Space (VLLDCS) Compliance Credit. If compliance credit for verified
Allowed
low leakage ducts in conditioned space is shown in the special features section of the CF-lR, the leakage to outside test
Leakage
method must be used to verify duct leakage (refer to RA3.1.4.3.4), and 25 CFM must be entered for Allowed Leakage.
(CFM)
Allowed leakage calculation — (select one calculation method from this section). Use 6% (leakage factor = 0.06) for
calculations. When utilizing Low Leakage Air Handler (LLAH) credit, the allowed duct leakage may be specified by the
CF -111 to be less than 6%, in which case the user-specified leakage rate must be used in the calculations below. For
example, if the user-specified leakage (specified as a percentage of fan airflow) is reported on the CF -1R as 3%, then
use aleakage factor of 0.03 in the calculations below.
❑ Cooling system method:
Nominal capacity of condenser in Tons x 400 x leakage factor = CFM
❑ Heating system method:
21.7 x Output Capacity in Thousands of Btu/hr x leakage factor = CFM
❑ Measured airflow method (RA3.3):
Enter measured fan flow in CFM here x leakage factor = CFM
Enter value for Actual leakage (CFM) in the right column, from measurement using applicable duct leakage
Actual
Leakage
pressurization test procedure from Reference Residential Appendix RA3.1(CFM @ 25 Pa).
(CFM)
List Actual Leakage from duct leakage test(CFM)
Pass if Actual Leakage is less than Allowed Leakage ❑ Pass ❑ Fail
For complete replacement of duct systems only, if the 6 percent leakage rate criteria cannot be met, a smoke test
should be performed to verify that the excess leakage is coming only from a pre-existing furnace cabinet (air handler
cabinet), and not from otheraccessible portions of the duct system. A HERS rater must verify the installation (No
sampling allowed).
List Actual Leakage from smoke test(CFM)
Pass if all accessible leaks (except for existing air handler) are sealed using smoke ❑ Pass ❑Fail
Reg: 212-N0035872A-M2000074A-M20A Registration Date/Time: HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms August 2009
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-20
Duct Leakage Test - Completely New or Replacement Duct System (Page 2 of 2)
Site Address: Enforcement Agency: Permit Number:
50730 Mandarina, La Quinta CA 92247 (System 2) City of La Quinta 7
Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off during duct leakage
esting. CFI OA ducts that utilize controlled motorized dampers, that open only when OA ventilation is required to meet ASHRAE
Standard 62.2, and close when OA ventilation is not required, may be configured to the closed position during duct leakage testing.
All supply and return register boots must be sealed to the drywall
13 New duct installations cannot utilize building cavities as plenums 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 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 -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 -611)
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
GHA Companies
Responsible Person's Name:
Rudy Herrera
CSLB License:
N/A
HERS Provider Data Registry Information
Sample Group # (if applicable): 331028
❑ tested/verified dwelling
® not-tested/verified dwelling in a
HERS sample group
HERS Rater Information CalCERTS Certificate # CCI -1798671609
HERS Rater Company Name:
Responsible Rater's Name:
Tom Bachus
Responsible Rater's Signature:
Tom Buchus
Responsible Rater's Certification Number w/ this HERS Provider:
CC2005932
Date Signed: 11/7/2012
Reg: 212-N0035872A-M2000074A-M20A Registration Date/Time: HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms August 2009
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-22
HSPP/PSPP Installation: Cooling Coil Airflow (Page 1 of 2)
Site Address: Enforcement Agency: Permit Number:
50730 Mandarina, La Quinta CA 92247 City of La Quinta 7
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.
Hole for the placement of a Static Pressure Probe (HSPP), and Permanently installed Static
Pressure Probe (PSPP) in the supply plenum
When the Certificate of Compliance (CF1R )indicates Cooling Coil Airflow or Fan Watt Draw verification are required, HSPP or PSPP
are required to be installed in each air handler in the dwelling. Procedures for installing HSPP and PSPP are described in Reference
Residential Appendix RA3.3. This measure requires verification by a HERS rater.
Select one method from the two choices below for compliance with the HSPP/PSPP requirement for this dwelling.
13
HSPP
1/4 inch (6 mm) hole labeled and located downstream of the evaporator coil in the supply plenum as
System Name or Identification/Tag
shown in the figure in Section RA3.3.1.1.
13
PSPP
1/4 inch (6 mm) hole equipped with a permanently installed pressure probe, labeled and located
downstream of the evaporator coil in the supply plenum as shown in the figure in Section RA3.3.1.1.
System Name or Identification/Tag
System i
System 2
System Location or Area Served
Master
Great Room
Confirm that a HSPP or PSPP has been
Calculate the target minimum airflow for the test by multiplying the CFM/ton criteria
specified on the CF -1R by the nominal cooling capacity of the outdoor unit (ton).
Target (CFM)
installed on the air handler per the
requirements of RA3.3.1.1.
Enter Pass or Fail
The system complies if Tested (CFM) is equal or greater than Target (CFM).
Enter Pass or Fail
Cooling Coil Airflow Verification
When the Certificate of Compliance indicates Cooling Coil Airflow verification is required, the procedures for measuring the cooling coil airflow must be
performed as specified in Reference Residential Appendix RA3.3. Results of the cooling coil airflow diagnostic test must be entered in the table below.
This measure requires verification by a HERS rater.
Select one method from the three choices below for compliance with the Cooling Coil Airflow test requirement for this dwelling.
❑ Diagnostic Fan Flow Using Plenum Pressure Matching according to the procedures in RA3.3.3.1.1
❑ Diagnostic Fan Flow Using Flow Grid Measurement according to the procedures in RA3.3.3.1.2
❑ Diagnostic Fan Flow Using Flow Capture Hood according to the procedures in RA3.3.3.1.3
System Name or Identification/Tag
System Location or Area Served
Nominal Cooling Capacity (ton) of the outdoor unit.
Enter the minimum airflow requirement from the CF -1R (CFM/ton).
Calculate the target minimum airflow for the test by multiplying the CFM/ton criteria
specified on the CF -1R by the nominal cooling capacity of the outdoor unit (ton).
Target (CFM)
Enter the diagnostically tested airflow (CFM).
Tested (CFM)
The system complies if Tested (CFM) is equal or greater than Target (CFM).
Enter Pass or Fail
Reg: 212-N0035872A-M2200075A-M22A Registration Date/Time: HERS Provider: CalCERTS; Inc.
2008 Residential Compliance Forms March 2010
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-22
HSPP/PSPP Installation: Cooling Coil Airflow (Page 2 of 2)
Site Address: Enforcement Agency: Permit Number:
50730 Mandarina, La Quinta CA 92247 City of La Quinta 7
Fan Watt Draw Verification
When the Certificate of Compliance indicates Fan Watt Draw verification is required, the procedures for measuring the Fan Watt Draw must be
performed as specified in Reference Residential Appendix RA3.3. Results of the Fan Watt Draw diagnostic test must be entered in the table below.
This measure requires verification by a HERS rater. Note: Fan watt draw must be measured simultaneously with cooling coil airflow. The fan watt draw
measurement and cooling coil airflow measurement must simultaneously meet or exceed their target criteria specified by the CF -IR for the dwelling.
Select one method from the two choices below for compliance with the Fan Watt Draw test requirement for this dwelling.
❑ Portable Watt Meter Measurement according to the procedures in RA3.3.2.2.1
0 Utility Revenue Meter Measurement according to the procedures in RA3.3.2.2.2
System Name or Identification/Tag
System 1
System 2
❑ tested/verified dwelling
® not-tested/verified dwelling in a
HERS sample group
System Location or Area Served
Master
Great Room
Responsible Rater's Signature:
Tom Bachus
Responsible Rater's Certification Number w/ this HERS Provider:
CC2005932
Enter the air handler Tested (CFM) from the cooling coil airflow test table above.
Enter the fan watt draw requirement from the CF -IR (Watt/CFM).
Calculate the target maximum Watt draw for the test by multiplying the
Watt/CFM criteria specified on the CF -111 by the air handler Tested (CFM).
Target (CFM)
Enter the diagnostically tested Watt draw (Watt).
Tested (Watt)
The system complies if Tested (Watt) is less than or equal to Target (Watt)
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 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 reouirements specified on the Certificate(s) of Compliance (CF -1R) aDDroved by the enforcement aciencv.
Builder or Installer information as shown on the Installation Certificate (CF -6111)
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
GHA Companies
Responsible Person's Name:
Rudy Herrera
CSLB License:
N/A
HERS Provider Data Registry Information
Sample Group # (if applicable): 331028
❑ tested/verified dwelling
® not-tested/verified dwelling in a
HERS sample group
HERS Rater Information CaICERTS Certificate # CC1-1798671609
HERS Rater Company Name:
Responsible Rater's Name:
Tom Bachus
Responsible Rater's Signature:
Tom Bachus
Responsible Rater's Certification Number w/ this HERS Provider:
CC2005932
Date Signed: 11/7/2012
Reg: 212-N0035872A-M2200075A-M22A Registration Date/Time: HERS Provider: CalCERT8, Inc.
2008 Residential Compliance Forms March 2010
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-23
Verification of High EER Equipment (Page 1 of 1)
Site Address: Enforcement Agency: Permit Number:
50730 Mandarina, La Quinta CA 92247 City of La Quinta 7
Verification of High EER Equipment
Procedures for verification of High EER Equipment are described in Reference Residential Appendix RA3.4. For dwelling units with
multiple systems, the procedures must be applied to each system separately. 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.
1
System Name or Identification/Tag
System 1
System 2
HERS Provider Data Registry Information
Sample Group # (if applicable): 331028
2
System Location or Area Served
Master
Great Room
Responsible Rater's Name:
Tom Bachus
Responsible Rater's Signature:
Tom Bachus
3
Certified EER Rating of the installed equipment (Btu/Watt-hr)
4
Make and Model Number of the installed Outdoor Unit
5
Make and Model Number of the installed Inside Coil
6
Make and Model Number of the installed Furnace or Air Handler.
7
Minimum Equipment EER required for compliance as reported on the
CF -1R
❑ When a high EER system specification includes a time delay relay, the installation of the time delay relay must be verified for compliance credit.
Refer to Reference Residential Appendix RA3.4.3 for the Time Delay Relay Verification Procedure.
❑ When installation of specific matched equipment is necessary to achieve a high EER, installation of the specific equipment must be verified for
compliance credit. Refer to Reference Residential Appendix RA3.4.3 for the Matched Equipment Verification Procedure.
If the Certified EER Rating in row 3 is equal to or greater than the
8
required minimum EER in row 7, the unit complies.
SAMPLED
SAMPLED
If the unit complies enter Pass
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.
• 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)
GHA Companies
Responsible Person's Name:
Rudy Herrera
CSLB License:
N/A
HERS Provider Data Registry Information
Sample Group # (if applicable): 331028
❑ tested/verified dwelling
® not-tested/verified dwelling in a
HERS sample group
HERS Rater Information CalCERTS Certificate # CCI -1798671609
HERS Rater Company Name:
Responsible Rater's Name:
Tom Bachus
Responsible Rater's Signature:
Tom Bachus
Responsible Rater's Certification Number w/ this HERS Provider:
CC2005932
Date Signed: 11/7/2012
Reg: 212-N0035872A-M2200075A-M22A Registration Date/Time: HERS Provider: CalCERTS, 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:
50730 Mandarina, La Quinta CA 92247 City of La Quinta 7
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 2
System Location or Area Served
Master Great Room
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 Evaporator Coil
System Name or Identification/Tag
3
❑ Yes
❑ 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.
The sensor wire is terminated with a standard mini plug suitable for connection to a digital
4
❑ Yes
❑ No
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
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 applicable.✓
[I N/A
✓ ❑Pass
✓ ❑Fail
Otherwise enter Pass or Fail
STMS - Sensor on the Condenser Coil
System Name or Identification/Tag System 1 System 2
6
❑ Yes
❑ 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.
The sensor wire is terminated with a standard mini plug suitable for connection to a digital
7
❑ Yes
❑ No
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 applicable.
✓ ® N/A
✓ ❑ Pass
✓ ❑ Fail
Otherwise enter Pass or Fail
Reg: 212-N0035872A-M2200075A-M22A Registration Date/Time: HERS Provider: CalCERT3, Inc.
2008 Residential Compliance Forms March 2010
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5)
Site Address: Enforcement Agency: Permit Number:
50730 Mandarina, La Quinta CA 92247 City of La Quinta 7
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 1
System 2
System Location or Area Served
Master
Great Room
Outdoor Unit Serial #
Outdoor Unit Make
Outdoor Unit Model
Nominal Cooling Capacity Btu/hr
Date of Verification
Calibration of Diagnostic Instruments
Date of Refrigerant Gauge Calibration (must be re -calibrated monthly)
Date of Thermocouple Calibration (must be re -calibrated monthly)
Measured Temperatures (°F)
System Name or Identification/Tag
System 1
System 2
Supply (evaporator leaving) air dry-bulb temperature
(Tsupply, db)
Return (evaporator entering) air dry-bulb temperature
(Treturn, db)
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: 212-N0035872A-M2200075A-M22A Registration Date/Time: HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
INSTALLATION CERTIFICATE CF-4R-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5)
Site Address: Enforcement Agency: Permit Number:
50730 Mandarina, La Quinta CA 92247 City of La Quinta 7
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)
System Name or Identification/Tag
Calculated Minimum Airflow Requirement (CFM)
Measured Airflow using RA3.3 procedures (CFM)
Passes if measured airflow is greater than or equal to the
calculated minimum airflow requirement.
I
Enter Pass or Faill
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: 212-N0035872A-M2200075A-M22A Registration Date/Time: 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:
50730 Mandarina, La Quinta CA 92247 City of La Quinta 77
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 =
Tsuction - Tevaporator, sat
Enter allowable superheat range from manufacturer's
specifications (or use range between 3°F and 26°F if
manufacturer's specification is not available)
System passes if actual superheat is within the allowable
superheat range
Enter Pass or Fail
Reg: 212-N0035872A-M2200075A-M22A Registration Date/Time: HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
;NSTALLATION CERTIFICATE CF-4R-MECH-2!
tefrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5;
Site Address: Enforcement Agency: Permit Number:
50730 Mandarina, La Quinta CA 92247 City of La Quinta 7
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
System 2
® not-tested/verified dwelling in a
HERS sample group
HERS Rater Information CalCERTS Certificate # CCI -1798671609
System meets all refrigerant charge and airflow
Responsible Rater's Name:
Robert Bachus
Responsible Rater's Signature:
Robert Bachus
Responsible Rater's Certification Number w/ this HERS Provider:
CC2005695
Date Signed: 11/7/2012
requirements.
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 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.
• 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 -IR) 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)
GHA Companies
Responsible Person's Name:
Rudy Herrera
CSLB License:
N/A
HERS Provider Data Registry Information
Sample Group # (if applicable): 331028
❑ tested/verified dwelling
® not-tested/verified dwelling in a
HERS sample group
HERS Rater Information CalCERTS Certificate # CCI -1798671609
HERS Rater Company Name:
Responsible Rater's Name:
Robert Bachus
Responsible Rater's Signature:
Robert Bachus
Responsible Rater's Certification Number w/ this HERS Provider:
CC2005695
Date Signed: 11/7/2012
I
Reg: 212-N0035872A-M2200075A-M22A Registration Date/Time: HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
Certificate. of Occupancy
T4&f 4 4 4"
Building &. Safety Department
This Certificate is issued pursuant to the requirements of Chapter 1 Section R110 of the
California Residential Code, certifying that, at the time of issuance, this structure was in
compliance with the provisions of the Building Code and the various ordinances of the City
regulating building construction and/or use.
BUILDING ADDRESS: 50-730 MANDARINA
Use classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction: VB
Code Edition: 2010
GREG BUTLER
Building Official
Sprinkler Installed: YES
Building Permit No.: 12-0556
Land Use Zone: RL
Sprinkler Required: YES
Owner of Building: CITRUS 18 GROUP LLC
Address: 30875 DATE PALM DR
City, ST, ZIP: CATHEDRAL CITY, CA 92234
By: AJ ORTEGA
Date: JANUARY 3,S
OUS PLACE