Loading...
MECH (11-1198)50965 Mandarina 11-1198 P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application. Number: . -"11-0 0 0011,98 Property Address: -5096-5 MANDARINA APN: 772-210-019- - Application description: MECHANICAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 12737 Applicant: ce4440" BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Architect or Engineer: ------------------ LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty. of perjury that I. am licensed der provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professio Code, and my License is in full force and effect. License lass: C20 kens o.: 686310 it ate: A ontractor. O ER, -B ILDER 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 fora permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: (_) 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and. who does the work himself or herself through his or 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 1 hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: Lender's Address: ' LQPERMIT Owner: SMITH KERRY C 50965 MANDARINA LA QUINTA, CA 92253 Contractor: GENERAL AIR CONDITIONING 31170 RESERVE DRIVE THOUSAND PALMS, CA 92276 (760)343-7488 Lic. No.: 686310 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS Date: 3/;11 1—tiio V 0 3 201 Of ±.A 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 ZENITH INS CO Policy Number Z071741501 _ I certify that, in the performance of the ork for which this permit is issued, I shall not employ any person in any manner so as to beco subject to the workers' compensation laws of California, and agree that, if I should become s ect to the workers' compensation provisions of Section 3700 of the Labor Code, I shall fort ith comply with those provisions. ate: 1 3 scant: WARNING: FAIL E TO SECURE WORKER ' CO PENSATION 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, indemnity 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 ' ormation is correct. I agree to comply with all city an county ordinances an state laws relating to building co ruction, and hereby authorize representatives of county to enter upon eabove-mentioned property for i action purposes. 1 Date: ` 3 gnature. (Applicant or Agent): / Application Number . . . . . 11-00.001198 Permit MECHANICAL Additional'desc . Permit Fee 40.50 Plan Check Fee 10.13 Issue Date . . . . Valuation . . . 0 Expiration Date s. 5/01/12 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 NEW 5 TON HVAC SYSTEM, CONDENSER,- COIL AND FURNACE_AT GROUND LEVEL. 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 Address: En orcetne Agency: Date: Permit q: of t l -C/ Conditioned Floor Equipment T et List Minimum Efficiency Z Duct insolation requirement Area Thermostat Packaged Unit d dd f d 40 ft Over of added or Furnace ❑AFUE 80 % ❑COP KSetback re laced in unconditioned s ace Served b s stem door Coil ❑SEER ! 3 ❑ HSPF _ P P Y Y (/J•not already ondensing Unit ❑ EER / / ❑ Resistance ❑ R 6 (CZ 10-13J sf present, mast be 13 Other ❑ R 8 (CZ 14-15) installed) 1. Equipment Type: Choose the equipment being installed; if more than one system, ttse another CF -1 R -ALT -HVAC for each eystem. 2. Minimum Equipment Efficiencies: 13 SEER, 73% AFUE, 7.7HSPFfor typical residential systems. HERS VERIFICATION SUMMARY Listed below are foLir-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 si ed. Beginning October 1, 201.0, a re istered co of the CF -IR and CF -6R shall also be on site for final inspection. 1. HVAC Changeout I Required Forms; • All HVAC Equipment re laced CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH- 25 -HERS P rn no r---. .,rnnr.' 2008 Residential Compliance Forms AWI, .- A In to • Condenser Coil and /or '- IIJ IYI L:IiI I-L'.J • Indoor Coil and/or CF-611forms: 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 fr m duct leakage testing if: 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 Changeout with new ducts: (all new ducting and all CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS new equipment) CF -411 forms: 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 forms: 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 fumace. 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 Required Forms: • Includes adding or replacing more than 40 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 ducts stems 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. • 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. • 1 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. • tion documented on other Pplic ompliance forms, worksheets, The design features identified on this Certificate of Compliance are consistent with the 'nwith calculations, and plans specifications submitted to the enforcement a enc fora ro al e ermit application. Name: Co It een W 561 Si ture: Company:A- G,en era,( 41r CortdDate: f•`o h t` Address: 31170 Peserve- t License: fit. City/State/Zip: — — a.LfS', G/ 9 a- 7 Phone: 7&0 -3 `13 - 74ff, 2008 Residential Compliance Forms AWI, .- A In to CaICERTS - CF -1 R Registration Page 1 of 1 Public Home Danielle Garcia logged in [Logout] [Home] Secure Home About Us Training Rater Directory CONGRATULATIONS Your CF -IR -ALT -HVAC Registration is complete! You may want to print this page for your records. Site Address: 50965 MANDARINA STREET La Quinta, CA 92253 CEC Registration: 211-AO0570OIA-00000000-0000 Forms CF -IR -ALT -HVAC: CLICK HERE TO DOWNLOAD [CLICK HERE] to do another Copy rialy e0 20 1. 0 CaICERTS. Inc. All rights reserved. Revised:January 11. 2010 [Terms and Conditions] [Privacy Statement] [Class Cancellation Policy] CaICERTS, Inc., 31 Natoma St Suite 120, Folsom, CA 95630 Office: 916-985-3400,Toll Free: 877-HERS-R8R, (877-437-7787) Fax: 916-985-3402 Contact Us T BBB #irtdus,oreFaaebOt3kQ,! u, https://www.calperts.com/public_cflR.cfm?project_id=147370 11/2/2011 Assigned Company: 1HARRISON ENTERPRISES INC - Membership Benefits` Do you know your HERS Rater? -If-you do—,you-maywant-to send this CF -IR to them.- hem. Industry Industry Partners CaICERTS Rater ID: News OR My Rater Quick Select:' Energy Driven Solutions, Inc. _ Every CaICERTS rater has a license number. To register for our Ifyou need to find the rater by name [Click HERE] to search our directory. monthly I ;_.SEND GFIRTCQHERS::RgTER.,_.,;,.;j - newsletter, please click here. [CLICK HERE] to do another Copy rialy e0 20 1. 0 CaICERTS. Inc. All rights reserved. Revised:January 11. 2010 [Terms and Conditions] [Privacy Statement] [Class Cancellation Policy] CaICERTS, Inc., 31 Natoma St Suite 120, Folsom, CA 95630 Office: 916-985-3400,Toll Free: 877-HERS-R8R, (877-437-7787) Fax: 916-985-3402 Contact Us T BBB #irtdus,oreFaaebOt3kQ,! u, https://www.calperts.com/public_cflR.cfm?project_id=147370 11/2/2011 9wq FINANCING THROUGH: REBATES /" TTL' 500 GENERAL * *Air Conditioning & Heating 31-170 Reserve Drive • Thousand Palms, CA 92276 (760) 343-7488 • Fax (760) 343-7494 www.callthegeneral.com Residential Comfort Survey INSTALL DATE ,2 JOB#' S CUSTOMER# i`Lor NAME JOB A] CTTV PHONE CELL FAX SEPARATE BILLING ADDRESS? ❑ YES ❑ NO NEW EQUIPMENT COND FAU COIL" 7 TSTATTj" a1 FILTRATION MISC s`a-'' PERMIT YES DUCT WORK ON Cl FINANCIN ❑ NO EXISTING EQUIPMENT COND M # FAUM# COIL M# UNIT LOCATION: S# S# S# CRANE? ❑ YES ❑ NO SIZE WARRANTY PLATFORM SIZE ATTIC HEIGHT CK. t C _: OPENING f • i ❑ CREDIT CARD ❑ C.O.D. ❑ COSTCO Kin #. City of La Quinta Building& Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA'92253 - (760) 777-7012 Building Permit -Application and. Tracking Sheet Permit # \ Project Address: b (aS Owners Name: A. P. Number: '. Address: Legal Description: Contractor:{ Address: City, ST, Zip:'— City, ST, Zip: G y :,<x: w Telephone: %(O SZ9 .x ,'^''< ' ' 2r, ..to ' •. rr. M. Project Description: Telephone: '`` •.',.r>: : ;`;;; :.: %. State Lic. # : 3 City Lic. Arch., Engr., Designer: - Construction Type: Occupancy: Address: City., ST, Zip: Telephone: • . `' ri% ,->. State Lic. #: - f •,• ^.{.`;gym, >s '. ✓ Project type .(circle one): New Add'n Alter Repair Demo . Name of Contact'Person: C p L c ✓t ;f-5 ZrYU Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: 7<a O 3 Y3 8''&' ' Estimated Value of Project: li -7 -7 ,®` APPLICANT: DO. NOT WRITE. BELOW THIS LINE # Submittal Plan Sets. Req'd Rec'•d TRACIGNG Plan Check submitted PERMIT FEES Item Amount Structural Cafes. Reviewed, ready for corrections Plan Check Deposit Truss Cales. Called Contact Person Plan Check Balance. Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2°" Review, ready for correctionsAssue 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 correctlonstissue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P.. Pub. Wks. Appr. Date of permit issue School Fees Total Permit Fees CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-21 Duct Leakage Test — Existing Duct System (Page .1 of 2) Site Address: 50965 MANDARINA STREET, La Quinta CA 92253 (System Enforcement Agency:' Per Number: 1) City. of La Quinta • 11-1198 , • Enter the Duct System Name or Identification/Tag: Enter the Duct System Location or Area Served: k' + Note: Submit one Installation Certificate for each duct system'_ that must demonstrate compliance in the' dwelling. This installation certificate is required for compliance for alterations and additions in existing dwellings to, space conditioning systems and duct systems. Note: For existing dwellings, a completely new or replacement duct system can also include existing parts of the original duct system (e.g., register boots, air -handler, coil, plenums; etc.) if those parts are accessible and they can be sealed. For a completely new or replacement duct system installed in, an existing'dwelling, use the Installation Certificate"titled "Duct Leakage Test - Completely New or Replacement Duct System. " Duct Leakage Diagnostic Test - existing duct system Select one compliance method from the following four choices. ❑ 1.• Measured leakaqe,less than 15% of fan flow_ 2. Measured leakage to outside less than 10% of.Fan Flow . r k z ; , •• } kg- ❑ 3. Reduce leakage by 60%o and conduct smoke and fix all leaks+ using oke 4.,.Fix all accessibleleaks s and HERS rater verify 4 Note: (One of O tions 1" 2 or 3 mus tti'e.attem.ted before utilizin 0 tion 4., 1 P a s P m m ,g P ) Determine nommaPFai),' using one of themfollowin three calculation methods , as k f f, b ❑ Cooling„system method: Size in 400 CFM i of condenser Tons x - qN ❑ Heating system.method; 217 x=a Output Capacity inTho sands of Btu/hr _CFM fi tij P. ❑ MeasuryedsysEemrflowustngRA3 3airflorywte5tpocedures _CFM ' Opt onT3?usedythen' ” ' , Fan "CFM 1 Allowed leaks a Flow xt0 15 9 AuaLeaka e CFM 9 ' ' ~ Allowed '. Pass if Leakage Actual is less than Pass Fail Option 2 used then : > Allowed leakage Fan t 0.10 CFM s 2 Flow x - • Actual Leakage to outside NAI 'CFM •Pass if Leakage Actual is less than Allowed Pass jj Fail' + 17 Option 3 used then; , '1 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.,__) x100% _ % Reduction Pass if b Reduction >,60% Pass Fa'il Option 4 used then: w M 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 17 Reg: 211-A0057001A7M2100001A-M21A Registration Date/Time:-20 11/12/02 18:1146: 15 HERS Provider: Ca10ERTS, Inc -' 2008- Residential '`Compliance Forms s r March 2010' CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING • CF-4111-MECH-21 Duct Leakage Test — Existing Duct System (Page 2 of 2) Site Address: 50965 MANDARINA STREET, La Quinta CA 92253 (System Enforcement Agency: 'Permit Number:• 1) City of to Quinta' 11-1198 A. ry• :. •' > ro P qtr ,., ' • + ", - `I - y • ' t' of + l r . •} 1,i ,1 ' ❑ Outside air (OA) duets for Central Fan Integrated (CH)l- entilatioh systems, shall not be sealed/taped off = during'duct leakage testing CFIOA ducts that utilize controlled motorized dampers; that open only when OA ventilation is required to,meet ASHRAE Standard 62.2, and close,wh. en OA ventilation is not required, may, be configured to the closed posifn during duct leakage testing , ❑ All supply and return register boots mustbe sealedto"thedryw,al cif smoketest s utlhd,'for"compllancef . c. r ; 3+ , "5* t_ .-.ter• y t - applies towtt leakage compliance op"tion.3 (leakage reduction by.'60 /0) and option 4. (fix all accessible ..leaks) de scn6ed above z ,. ,., ❑ New du t install:atioonns• cannot' I ilize buildfi g cavit es as plenums or platform returns m lleu`of dints ` s r CJ ti and draw bands :must be usedincombination with clothnbacked'rubber adhesive duet tape to seal leaks at all new duct connections < =, t ++ DECLARATION STATEMENT`,' 4 , 1 certify under penalty of perjury under the laws of the State of California,. ther information provided on this form is true and correct s. 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'spe,cified n on the Certificates) of Compliance (CF -111) approved by the local enforcement agency. rte, The information reported on applicable sections of the Installation Certificate(s) (CF -611), signed and submitted by the person(s) f.• *; 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 -6111) Company Name: (Installing Subcontractor or. General Contractor or Builder/Owner) s HARRISON ENTERPRISES INC ; Responsible Person's Name: CSLB License`. Danielle Garcia 686310 R , HERS Provider Data Registry Information Sample Group # (if applicable): 258030 E) tested/verified dwelling not-tested/verified dwelling in ` a HERS sample group HERS Rater Information' CaICERTS Certificate # CC171798604695 HERS'Rater Company Name; Energy Driven Solutions, Inc. t` Responsible Rater's Name: Responsible Rater's Signature: David Bricker; , bavid Bricker t. Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: '11/30/2011' CC2004131 14 Reg: 211-A0057001A-M21'00001A-M21A Registration Date/Time: 2011/12/02 f8.'46': 15" HERS Provider:' Ca10ERTS, Inc. 2008 Residential Compliance Formsa , ", March 2010' r CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-25 =' Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of,S) Site Address: Enforcement Agency: Permit Number: 50965 MANDARINA STREET, La Quinta CA 92253 City of La Quinta 11-1198 v Note: If installation of a Charge Indicator Display (CID) is utilized as an alternative to refrigerant charge verification for compliarnce,'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 systems in the,dwelling'can be documented for compliance using this form Attach an additional form(q) for any additional systems in the dwelling as applicable. Temperature Measurement Access Holes (TMAH) and SAturation.Temperature Measurement' , J 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 ori 't • 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 Location or Area Served - 3 Ys5 _._. M rl.No.. 5/16 inch (8 mm) access hole upstream of evaporative coil in the return plenum and labeled'ac-coedin9to Fi —re -Sectib 'PA3 2.x.2`2. . ig- 2 El 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 =1" and 2 is a pass.. .` Enter Pass or Faill V 0 Pass V ❑fail STMS Sensoronthe EvaporatoCoil , r • 1 ; ` System`Namerorldentifeation/Tag- j ,i I« 3 X'II • ° ®Yes ®No The°sensor is factory'installed or fieldwnstalled acco ding to nianufactui•er s b a i . Win. • specifcations, or ismstalled by methods/specifications approved by the,Executive , ❑ Yes - .❑ No, specifications, or is installed by methods/specifications approved by the Executive ' DirectorJEW AAM . .. _ •„ter=. 4. ply £The sensor wirers” terminated, with a$standardrriim plugisuitable four connectionsto a l•kd +aUx'u9eL.7" dn"II d ,8 @ 13•x'.. '. 14u .,M'.Yalrzed3s^ c digital thermometer Thexsensor mini plug is accessible to the installing technician XWWpd K1/ W The sensor wire is terminated with a standard mini plug suitable for connection to a . ?:;5>a3°^i6 Y*r. +3: •y ,"s - WE :. A'a Sv+w .Nf. }4',r' :and the HERS cater without:changing-the'aiMdW through the condenser coil 5 El Ye z ❑ No When attached to a digital thermometer, the'sensor provides an indication of the " 'coil. :._ and the HERS'rater without changing the airflow through the condenser coil turation temperature:of the Yes to 3 4 an S'is a pass Enter N/A:if STMS are not applicable. Otherwise enteF,;;Pass o Fail N/A . Pass ✓ ❑ Fail, saturation temperature of the coils Yes to 6, 7, and 8 is a pass. Enter N/A if STMS are not STMS - Sensor on the Condenser Coil , { System Name or Identification/Tag , The sensor is factory installed, or fieldinstalled according to manufacturer's i 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 El 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 El Yes - El No When attached to a digital thermometer, the sensor provides an indication of the ' saturation temperature of the coils Yes to 6, 7, and 8 is a pass. Enter N/A if STMS are not " N/A ✓ ❑Pass ' ✓ '❑ Fail applicable. Otherwise enter Pass or Fail Reg: 211=A0057001A-M2500001A-M25A Registration'Date/Time: 2011/12/02' 18:.48.03 HERS Provider.: Ca10ERTS, Inc. 2008 Residential Compliance'Forms March 2010 g CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING , CF-4R-MECH=25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 -of S) r? Site Address: Enforcement Agency: Permit Number: 50965 MANDARINA STREET, La Quinta CA 92253 Cit La,Quinta 11.-1198 Standard Charge Measurement Procedure (for use if outdoor air dry-bulb is above 550F) 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. - i y 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. r • If outdoorair dry-bulb is 55°F or below, the installer must use the Alternate Charge Measurements Procedure.,,, Space Conditioning Systems 3 Date `of Refrigerant .Geuge Calibratio !tea, `._ B (must be [e -calibrated monthly)) ...+__-..• ....,,_ _.:,eiP .. Date of Therrnocouple Ci librationANN i •A (@rm ust be re` a'liybra ed monthly) n . ,. .r •: X rJ rix,' . '• ' r r . . r', f', ` r. , j i, 4 y, •,r 's «gy f " ' Jew,:. / Return (evapgr4ator entering) air dr' UUlb temperature (Tre'w', g CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING , CF-4R-MECH=25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 -of S) r? Site Address: Enforcement Agency: Permit Number: 50965 MANDARINA STREET, La Quinta CA 92253 Cit La,Quinta 11.-1198 Standard Charge Measurement Procedure (for use if outdoor air dry-bulb is above 550F) 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. - i y 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. r • If outdoorair dry-bulb is 55°F or below, the installer must use the Alternate Charge Measurements Procedure.,,, Space Conditioning Systems 3 Date `of Refrigerant .Geuge Calibratio !tea, `._ B (must be [e -calibrated monthly)) ...+__-..• ....,,_ _.:,eiP .. Date of Therrnocouple Ci librationANN i •A (@rm ust be re` a'liybra ed monthly) vs.. Measured Temperaturee('F) System Name or Ideyntificat ioF nv/ne Tagy" u ` n i •A /•1'i.txr iiF>I'&X. _ka vs.. Measured Temperaturee('F) System Name or Ideyntificat ioF nv/ne Tagy" u ` /•1'i.txr iiF>I'&X. _ka Supply, (evapbratorleaving)air dry bulbi aha tempeeature':(T .,.:. supplYr db) O ' Return (evapgr4ator entering) air dr' UUlb temperature (Tre'w', db)ARVE Return (evaporator entering) air wet'.'bulb = temperature (T) return, wb Evaporator saturation temperatures (Tevaporator, sat) , Condensorsaturation temperature ►' • ' .. } * vY. (Tcondensor, sat) F" s. ` it -tq `. Suction line temperature (T • suction) Liquid Line Temperature (Tliquid) Reg: 211-A0057001A-M2500001A-M25A Registration Date/Time: 2011/12/02.18:48:03• -HERS Provider,:'Ca10ERTS, Inc. 2008 Residential Compliance-Forms' Condenser (entering) air dry-bulb March 2010 ,. temperature (Tcondenser, db) € •, . *`. ' .. } * vY. F" s. ` it -tq `. Reg: 211-A0057001A-M2500001A-M25A Registration Date/Time: 2011/12/02.18:48:03• -HERS Provider,:'Ca10ERTS, 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: 50965 MANDARINA STREET, La Quinta CA 92253 City of La Quinta 11-1198 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 tf . Tsa perature .split .Method Calculation.i5-not-necessaaclf actual-Coo!i4g Goil...Aidloru is -verified using. one. of the_. airf7ow-F+vEasurem&.7t.prrce, 4ures specifaed-in Reference Residential Appendix RA3.3. If actual -cooling -coil-airf.'ow 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 NameIbf-I ll`htification/Tag Calculated Minimum Airflow°Requirement (CFM) k J$ Measured Airflow using 'RA3.3 procedures (CFM) "Y, ak f i:' K''F 7tl i ail Passes if measured airflow is'greater"than ors'equal aK<<¢- .I - '.• 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-A0057001A-M2500001A-M25A Registration Date/Time: 2011/12/02 18:48:03. 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: } 50965 MANDARINA STREET, La Quinta CA 92253 . City of La. Quinta.: 11-1198 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 ti r ` Calculate: Actual Subcooling = Tcondenser, sat - Tliquid Target Subcooling specified by manufacturer .. F manufacturer's specifications" (or user:'ange . • 1 4 Calculate difference:' Actual Subcooling -,Target Subcooling System•passeslif-hactual superheat is within tfie « ..SA9 Li U - 4 '• allowable superheat range m* $G System passes if difference is between - JAt" -VF 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.Id.entification/Tzo_ .^..,. ... r Calculate: Actual Superheat = tr `t. Tsuction - Tevaporator, sat Enter allowable superheat range from .. F manufacturer's specifications" (or user:'ange . between 3°F and 26°F if manufacturers specification is not available) System•passeslif-hactual superheat is within tfie « ..SA9 Li U - 4 '• allowable superheat range m* $G _Enter Pas; or. Fail - JAt" y f, r .. F 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.., r; System Name or Identification/Tag Danielle Garcia 686310 ^' ' HERS Provider Data'Registry Information • " " - Sample Group # (if applicable): 258030 ❑ tested/verified dwelling not-tested/verified dwelling in-. la ,. * HERS sample group , System meets all refrigerant charge and airflow' HERS Rater Company Name: L• Energy Driven Solutions,' Inc. Responsible Rater's Name: , Responsible Rater's Signature:_' 'requirements. i ricker Dovid Bricker- Responsible Responsible Rater's Certification Number w/ this HERS Provider- r CC2004131 Enter..Pass or Fail + M d, .. : } v , 4 r , ' z D. 41 ' g Jk E a •` A ] it ";. - DECLARATION STATEMENT u ` I certify under penalty of perjury, ander the laws of the State of California, the information provided on this form is true and correct. 1 I am the certified HERS raterwhop' erformed the verification services identified and reported on this certificate (responsible rater). ,.. r,v: The installed feature, material component, or manufactured device requiring HERS verification that is identified on this certificate (the-". ' installation) complies with the.appli cable 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 InstallationACertificate(s) (CF -611); signed and submitted by the person(sy, k .r responsible for the installation conforms to the requirements specified on the Certificates) 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) HARRISON ENTERPRISES INC Responsible Person's Name; CSLB License: Danielle Garcia 686310 ^' ' HERS Provider Data'Registry Information • " " - Sample Group # (if applicable): 258030 ❑ tested/verified dwelling not-tested/verified dwelling in-. la ,. * HERS sample group , HERS Rater Information CaICERTS Certificate # CC1-1798604695 - HERS Rater Company Name: L• Energy Driven Solutions,' Inc. Responsible Rater's Name: , Responsible Rater's Signature:_' .David Bricker ricker Dovid Bricker- Responsible Responsible Rater's Certification Number w/ this HERS Provider- Date Signed: 11/30/2011 CC2004131 Y r a, ;i INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS Duct Leakage Test'- Existing Duct System(Page i of 2) Site Address: 50965 MANDARINA STREET, La Quinta CA 92253 (System Enforcement Agency: Permit Number: *i City of La ,Quinta . 11-1198 , This installation certificate is required for compliance for alterations and -additions in existing, dwellings to,. ; space conditioning systems and duct systems. _ + Notec,. For existing dwellings, a completely new or replacement duct system can also include existing parts of ' the original duct system (e:g., register boots, air Handler, coil, plenums,'etc.) •if those parts are accessible " and they can be sealed. For a completely new or replacement duct system installed in'an-existing dwelling,' use the.Installation Certificate titled "Duct Leakage Test Completely" New or Replacement Duct System. Duct Leakage Diagnostic Test= existing duct system Select one compliance method from the following four choices. ® 1.; Measured AFakage jiess, ❑ 2. Measured leakage to_outside less than 10°Io of Fan"Flow p 3. Reduce leakage by. 60% and conduct smoke and fix all leaks , • ry ,: ^ ire_ w f _ 4.. Fix all accessible leaks using smoke and HERS rater verify' + + Note: ;One,of O attSi; s 1,2 or 3 must lie attempted before utilizing Option 4.)----------------- + . Determine nommalrFan,Flow usingone of the€,following three caI U15tion methods k ✓ 2 Coohngsystem method: Size of condenser m Tons + 5 x 400 =2000 CFM 3 ,. Y ❑ Heatingsystem method: 2 7 x Output Capacity I Btu/hr CFM q: ands of _ ✓ 0 Measuredjsyste n arflowusingRA3. 3 airflowest proced ues_GFM` T" , O t on1`usedthen` :2 ' P rb 1 Allowed leakage —Fan, Airflow2000 - x 0:15 '- 300 ' CFM , Actual LeakageX , 112 CFM. Pass ifActual Leakage than Allowed leakage Pass Fail ` s`less Ootion'2 used Z Allowed leakage Fan?Airflow3 x 0.10 =/=CFM, Actual -Leakage to outside Yid_. CFM Pass if Actual leakage to'outside is les's than Allowed leakage Pass . Fail , Option 3 used then:: Initial leakage prior to start of work =` CFM Final leakage after sealing all accessible leaks using smoke test' • CFM ' ` ,.. : ' • T' fi a 3 Initial leakage _ - Final leakage i = Leakage reduction CFM' + = L ((Leakage reduction _/ Initial leakage i) x 100% _ 0/6 Reduction, * Pass if % Reduction > 604 Pass 11Fail 4 ` Option 4 used then: ,, r All accessible leaks repaired using smoke test. HERS rater must verify P g fy (No Sampling).. ; Pass if all accessible leaks, have been repaired using smoke . - Pass El Fail ,, INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS Duct Leakage Test - Existing Duct System (Page 2 of 2) Site Address: ,50965 MANDARINA STREET,. La Qui nta CA 92253 (System. Enforcement Agency: Permit Number: ' 1) City of La Quinta . 11-1198 4. 1, © Outside air (OA) ducts for Central Fan Integrated'(CFI) ventilation' systems, shall not be sealed/taped off during:duct leakage.testing CF OA ducts that utilize controlled., motorized-dampers, that open only when OA ventilation is required to meet ASHRAE Standard 62.2, and close'when'Okventil'ation is not required, may be configured, to the closed position, during duct leakage testing. 8 All suppland return register boofitsmustbeseaetothedrywalllf rnoketestls utllfzedfor compliance - applies io duct'leakage compliance optlon.3 (leakag,e` reciuctlon by.;60%).and option 4 (.fix all accessible leaks) described abo 7ON 'Ti, r u D New duct lnstallatlonscannotu Ihze buildingLLcav tMies as plenumsor platform returns In lieu of dfucts s tT 0 Mastic an. d draw bands mustbeusedincombinatlon swlth'clothb'ackedrubber'adhesive-ducttape to seal leaks at all new duct connections= '.DECLARATION STATEMENT y ;, ' ' , • y • I certify under penalty of perjury, u9n erithe 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 k= 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 y required to take corrective action at my expense. I understand that Energy Commission and HERS provider representatives will also perform quality assurance checking of installations, including those approved as part of a sample group but not checked by a HERS rater, and if those installations fail to meet the requirements of such quality assurance checking, the required corrective action and + additional checking/testing of other installations in that HERS sample group will be performed at my expense.' • I reviewed a copy of the Certificate of Compliance (CF -111) form approved by -the enforcement agency that identifies the specific' requirements for the installation. I certify that the requirements detailed on the CF -111 that apply to the installation have been met +T' • 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.orBuilder/Owner) i HARRISON ENTERPRISES INC Responsible Person's Name: Responsible Person's Signature: r, Danielle Garcia banielle Garcia. CSLB License: 686310 Date Signed: 11/2/2011 Position.With Com an Title P y,(. 4 Is this installation monitored. by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? [I Yes ❑ No - x 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 SIMS_ are not required for compliance, when a CID is utilized for compliance. r As many as 4 systems in the dwelling can be documented for.compliance using this form. Attachanadditional 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 '-y 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 r System Name or Identification/Tag System i System Location or Area. Served .Living •-1 -' • •- Yes=• -- ---p-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 El -No f 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.i..and 2 is a pass. " `• Enter Pass or Fail ✓ Pass ✓ ❑fail STMS:- Sensor on the Evaporator Co l System'Narneor Ide•ntification/Tag ; `' • • 3 Yes ' The senso'r-is factoryn•stalled, `or,fieltl tinstalled accortling to 'manufacturer's E]Yes E { pNo .7,,. "3x3 1- sD'e coat ons, or isinstalged by methodsyy/specificat on pproved= by th'e Executive Ss.x m.w s '. . . 7 . " " rf...". %.•i"_''t `.a '& .'.,t+F5 .4 ®Yes ❑A No : ;. iThe2sensor wire.isNterrriinated w th astandard min plug suitable forr,connectio-"' ate`" digittalitthermomete The sensor, ni ug is accessstible•to,the; nstaliling tech,iciaii ' .•. k k land the HERS rater without changingahe airtlow through the't enser.coil ; 5 ❑ Yes ❑ No i T he'sensor measures the saturation temperature of the coil within 1.3 degrees F Yes to 3, 4;land ,54ittS pass. Enter N/A' if STMS are not applicable`Otherwise enter Pass orFail ✓ p N/A _ . ✓, ❑ Pass ✓ ❑ Fail ❑ Yes ❑ No IThe 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 STMS - Sensor on the Condenser Coil r System Name or Identification/Tag • System 1 - i The sensor is factory installed, or field installed according to manufacturer's 6 E]Yes C1No 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 ElYes' . ❑ 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 IThe 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 ` D N/A ✓ p Pass ✓ El Fail applicable. Otherwise enter Pass or Fail - i i. . r A, jt ya .. r 4L L Inc. ' Reg: 211-A0057001A-M2500001A-0000 Registration.Date/Time: 2011/12/02 '17:47:18 HERS Provider: CalCERTS, 2008 Residential Compliance Forms + `,'r August 2009 1; J, ..w.t INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5) Site Address: Enforcement Agency: Permit Number: 50965 MANDARINA STREET, La Quinta CA 92253 City of La Quinta f 11-1198 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 (must be re -calibrated monthly) +tc System Location or Area Served Living #.`•' (musCbe re- calibrated monthly) fi°,f' siFf'.,'% ,cosi°^"P Outdoor Unit Serial # 5811C10797 Outdoor Unit Make Lennox Outdoor -Unit Model XC21-060-230 ; Nominal•Coolingia`pacity Btu/hr -""" Date of Verification 11-2-11 ' w-anoraiion'or uiagnosric anstruments Date of Refrigerant Gauge Calibration r,', i1-1-11 "' (must be re -calibrated monthly) +tc Date of Thyerrnocouple Calibration #.`•' (musCbe re- calibrated monthly) fi°,f' siFf'.,'% ,cosi°^"P _. • ` measures;. :emperaiures( r.) ,-. r ;g System Name or Identification/Tag Systemj Supply (evaporator.leavmg) air dry-bulb Fvi °. *`,,52 '* i temperature (TSuPpIY, db) Return (evaporator entering) air dry-bulb temperature2(Tret'`urn,db- ) db x ' 72 ; Return Return (evaporator entering) air wet=,bulb temperature (Treturn, wb) r. Evaporator saturation temperature`' 40 (Tevaporator, sat) Condensor saturation temperature. 78 (Tcondensor, sat) Suction line temperature (Tsuction) 63 , Liquid Line Temperature (T) 75 • 65 - . , I s liquid Condenser (entering) air dry-bulb temperature (Tcondenser, db) Reg: 211-A0057bO1A-M2500001A-0000 Registration Date/Time:,2011/12/02 17:47:18 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms. c August 2009, .. ; F j " •.. a'f t- - a .1 •r .fR '• ' 'A , i. sy.• •*_F' i , !- ;y ' S. `' .. - - 4 f. 'y ,. .. y !4 '} ,,.. , a C , ♦ }:, a , 4, ^ .ti ' f System Name or Identification/Tag System 1• Minimurn Airflow Requirement s 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, 20.00 db - Tsu I "db ' ! t '.. r x Target Temperature Split from Table RA3.2,3 21 " using Treturn, wb and Treturn, db Calculate difference: Actual Temperature Split - _1- •. ; i _ ' Target Temperature Split = Passes if difference is between -3°F and +3°F or, upon remeasurement, if between -30F and PASS +`. -100°F Enter Pass or Fail Note;. _T..enaberature Split Method Calculation is not:necessary if actual Coaling Coil Airflow iswerified using onp of the airflow measurement procedures specified in Reference Residential Appendix RA3.3. If actual cooling coil airflow is ' measured, the value must be equalto or greater, than the Calculated Minimum Airflow Requirement in the table.below. Calculated Minimum Airflow Req,gment (CFM)=Nominal:Coolin Capacity (ton) X 300 (cfm/ton) System Name -,.or Identfieation/Tago st m i `` _ 3 f / AT -MY, AKRMI CalculateditnimumI.'Airflow Regwreme (CFM) -17 Measuredil i'rflow .using RA3 3 proc dures (CFM) OR 91 M." 16 Passes if measured airflow is`greate "°than equal to the calculated minimum air`f ow t r' requirement` >' = EnterPass or. Fail Superheat Charge Method"Calcuiations for Refrigerant Charge Verification. This procedure is required to be used for fixed orifice metering device:systems r System Name or Identiflcation/Tag System 1 Calculate: Actual Superheat Tsuction - Tevaporator, sat ' ! t '.. Target Superheat from Table RA3.2-2 using' Treturn, wbr and Tcondenser, db r* Calculate difference: Actual Superheat - Target. Superheat System passes if difference is between -5°F and +5°F Enter Pass or Fail - tY ♦ .- .fir4-1 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 i '- Calculate: Actual Subcooling =. Tcondenser, sat - Tliquid .3.0 d ` ,z Target Subcooling specified by manufacturer 3 . ,,-' ., , • i • . Calculate difference: 0 ' Actual Subcooling - Target Subcooling _ • °, a. " System passes if difference is between- PASS,++ Oil M ,.; -3°F and. +3°F PASS `' y. r.. Enter Pass or Fail, a 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. :iystemName. orTdentifcation/Taa Calculate: Actual Superheat Tsuction - Tevaporator, sat d ` ,z Enter allowable superheat range frorn ., manufacturer's specifications (or use range between 4°F and 250'F if manufacturers 25 •' ' specification is not available) ,.. System passes ifactual superheat is' -Within theme allowable superheaf range ` PASS,++ Oil M ,.; `' ,Enterail 4H + "S' 1 * q.s i yl, •W C. 'n t ;> i .f .[ y. '+ L .. .. - 1 Jy A4 } • SN ra . b Standard Charge Measurement Summary: ....1. _ 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 . r' , System T CSLB License: 686310 position With Company (Title): System meets all refrigerant charge and airflow' Name of TPQCP •(if. applicable):: r T Control Program (TPQCP)? . ❑ Yes ❑ No t requirements. ` .PASS Enter Pass or Fail _ 1 . ... \ • N 4 - '.t i 3 •4.o-# x ,' ' w. i ` ' r. ' "` .. 'i } i `,pr i ' , e ?S a4?_ ,* ,, -t z• m«, ,w . « y `v w. F + , DECLAOT30N STATEMENT • I certify under penalty of perjury, bunder the laws of the State of California, the information provided on thishform is true and correct + ~` • I am eligible under Division 3 iif 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, lam required to take corrective action at my expense. I, understand that Energy Commission and HERS provider representatives will also f s' perform quality assurance checking of installations,, including those approved as part of a sample group but not -checked by a HERS w. 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.~,t • 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) t HARRISON ENTERPRISES INC - Responsible Person's Name:; - Responsible Person's Signature: Danielle Garcia s Danielle Garcia CSLB License: 686310 Date Sighed: 11/2/2011 r position With Company (Title): Is this installation monitored by a Third Party Quality , Name of TPQCP •(if. applicable):: r T Control Program (TPQCP)? . ❑ Yes ❑ No Z , ( _j+00"< oo G t9- HVAC Field Data Sheet Pg 1 oft Client Nae—hL tZ L i -T.,4 i CE- - Job # b ' Date Address c 96 S t1l X-14- L,11-61 Ph # 5'a,-7 Technician(s) — ''2 Permit # —(Cf j O Gauge/Thermocouple Calibration DaSplit ( Package ( Some Ducts Only ( A11 Ducts OW (Circle type of work) MSC I=Q4 , Equommt Data ZONE 1 ZONE 2? ZOAW.1 ZONE4 System Location or Area Served L, f'4 /fix Heating Equipment Make L LF Heating Equipment Model vl-f c— ARI Reference Number 433 51 Heating Equipment AFQE „ Duct Location (attic, crawlspace, etc.) -1 i C Duct R -Value (if ducts were installed) Heating Load c9 Heating Equipment Output Capacity (9 Condenser Make L c 6 Condenser Model Xc I - moo - Size in Tons SEER & EER vo Cooling Load O Cooling Capacity Q7 :WOW 21 Duct resat L4 Duct Ieakage pretest result Duct Leakage Final Result QACFMloon to pass (6%) PassIF" PassIFail n3WI efl I Dud Leakage Final Result -IN CFM/dm to pass (15%) pm1m Pass using 60% leakage reduction? Pass using smoke and visual inspection? MEC 22 or.WW,2. S 'Cooftg CWAi4fi<ow& i► n.:hrattDr+aw . Measured Air Volume from Now Grid or Hood All& NEW DUCTS Target: 3S0 CFM/tzm x Condenser Tons CumGEOUT Target: 300 CFM/ton x condenser Tons Measured air greater than Target? (YIN) Measured Fan Watt Draw Target 0.58 watts/measured CFM Measured Watts less than Target? Copyright 0 2011 EDS Ener® Driven Solotlom int HVAC Field Data Sheet Pg 2 of 2 Ment Name S'i 7 /- Job # if 1) Date-- MECH 2S Charge & Afrflow ZONE 1 ZONE ZONE 3 ZONE 4 Condenser Serial Number WIr. 19 Supply air dry bulb temperature ,2 Return air dry bulb temperature Return air wet bulb temperature Evaporator Saturation Temperature 40 Condenser Saturation Temperature Suction Line Temperature Liquid Line Temperature Suction Pressure Liquid Pressure ActualAiiftuirTempaww Target Temperature Split from Table RA3.2.3 Passes if difference is t 3" of Target Temp (Y/N) , L Actual Subcooling (t 4° of Target tao pass) 3 Target Subcooling fiiom Mfr. Actual Superheat (3 to 26° to pass) Outside air dry bulb temperature MECTI 26, -Weigh-fn Charging below SS° Actual Line Set length (ft) Nf's Standard Line Set Length (ft) Length Difference = Correction Factor (ounces per foot) Target Correction Factor x Length Difference System Charged to Target? (YIN) Other Data Minimum amps Maximum amps p Breaker size Compressor amps 83 Return Static Pressure Supply Static Pressure Supply Air Wet Bulb Temperature * • ALL APPUCABLE )m oN TIfISFORMMUST BB COMPLETED FOR EAat joa NO EXCEPTIONS: • • CopyrW 0 2011 EDS &=V Alin® SolaiioM lac. SMOIKE AND CARBON MONOXIDE ALARm RETROFIT VERIFICATION and 1 (Print Property Owner's Name) (Tenant's Name - if same as Owner write "Same") who own and/or live in the dwelling located at: , kAJQUkh)P%,LQ CA s (Address). verify that the smoke and carbon monoxide alarms required by the California Residential Code (CRC) have been installed in the dwelling, incompliance with the code and with the manufacturer's instructions and further that,.:hey-have-been-tested and do function -properly..• In an effort to enhance life safety within dwellings, CRC Section R314.6, R315.2 and CBC 420.4 require the retrofit of these alarms in existing dwellings "when alterations, repairs or additions requiring a permit and exceeding $1,000 in value are made. Generally, the alarms must be hard wired (I 10 volt) with battery back-up and all alarms are to be interconnected. If the installation of the alarms will require the removal of wall or ceiling finishes or there is no access by means of attic, basement or crawl space, then alarms may be solely battery operated and not interconnected. Alarms must be installed in all of the following locations within the existing dwelling: In all bedrooms (only require Smoke Alarms) ➢ Immediately outside of:each separate bedroom. (require Smoke and Carbon Monoxide Alarms) ➢ In each story level of the dwelling, including basements and habitable' attic rooms (require Smoke and Carbon Monoxide Alarms) These safety devices must be installed by the time a final inspection is requested for your project. I understand the above requirements and certify that we now have smoke alarms and carbon monoxide alarms installed that comply. We agree to comply with the CRC. in regards to. smoke alarms, carbon mono Ide alarms. f Sig ature of Owner Date Signature of Tenant Date ATTENTION OWNER - OCCUPANT: This is a Voluntary Smoke and Carbon Monoxide Alarm verification procedure. If you prefer a Building Inspector to perform the verification, you must arrange'`to have an adult present at the'. time of inspection, NOTE: This Verification is.only when normal access to the interior of the dwelling by the City of: uilding Inspector is not achieved during the course of project construction. It is normally used for projects such as re-roonng, re -siding, patio covers, swimming pools and the like. Y SMOIKE AND CARBON MONOXIDE ALARm RETROFIT VERIFICATION and 1 (Print Property Owner's Name) (Tenant's Name - if same as Owner write "Same") who own and/or live in the dwelling located at: , kAJQUkh)P%,LQ CA s (Address). verify that the smoke and carbon monoxide alarms required by the California Residential Code (CRC) have been installed in the dwelling, incompliance with the code and with the manufacturer's instructions and further that,.:hey-have-been-tested and do function -properly..• In an effort to enhance life safety within dwellings, CRC Section R314.6, R315.2 and CBC 420.4 require the retrofit of these alarms in existing dwellings "when alterations, repairs or additions requiring a permit and exceeding $1,000 in value are made. Generally, the alarms must be hard wired (I 10 volt) with battery back-up and all alarms are to be interconnected. If the installation of the alarms will require the removal of wall or ceiling finishes or there is no access by means of attic, basement or crawl space, then alarms may be solely battery operated and not interconnected. Alarms must be installed in all of the following locations within the existing dwelling: In all bedrooms (only require Smoke Alarms) ➢ Immediately outside of:each separate bedroom. (require Smoke and Carbon Monoxide Alarms) ➢ In each story level of the dwelling, including basements and habitable' attic rooms (require Smoke and Carbon Monoxide Alarms) These safety devices must be installed by the time a final inspection is requested for your project. I understand the above requirements and certify that we now have smoke alarms and carbon monoxide alarms installed that comply. We agree to comply with the CRC. in regards to. smoke alarms, carbon mono Ide alarms. f Sig ature of Owner Date Signature of Tenant Date ATTENTION OWNER - OCCUPANT: This is a Voluntary Smoke and Carbon Monoxide Alarm verification procedure. If you prefer a Building Inspector to perform the verification, you must arrange'`to have an adult present at the'. time of inspection, NOTE: This Verification is.only when normal access to the interior of the dwelling by the City of: uilding Inspector is not achieved during the course of project construction. It is normally used for projects such as re-roonng, re -siding, patio covers, swimming pools and the like.