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MECH (10-0873)54415 Avenida Martinez 10-0873 1 2. 4 P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Application Number: 10-00000873 Owner: Property Address: 54415 AVENIDA MARTINEZ HARVEY MARY APN: 774-253-019-8 -000000- 54415 AVENIDA MARTINEZ Application description: MECHANICAL LA QUINTA, CA 92253 Property Zoning: COVE RESIDENTIAL (760) 207-6123 Application valuation: 7751 Contractor: Applicant: Architect or Engineer: PALM DESERT AIR COND CO 42081 BEACON HILL C 9 PALM DESERT, CA 92211 (760)346-0677 Lic. No.: 374937 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License Classy: C20 4 Lic a No.: 374937 fDate: O ContracMr7-72 J/W l OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: 1 _) 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). (_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). (_) 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: 9/08/10 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 SOUTHERN INS Policy Number WSI003802-01 I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Codel shall forthwith,cpptply with those provisions. Date: #91 p ApplicaNF.= 4 uu 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 applicationbecomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and here uthorize representatives of this9ountfy t'o ter upon the above-mentioned property for in purpos Date: ! "' Signature (Applicant or Agenfr. rte% Application. Number . . . . . 10-00000873 Permit MECHANICAL Additional desc . Permit Fee . . . . 33.00 Plan Check Fee 8.25 Issue Date . . . . Valuation 0 Expiration Date . . 3/07/11 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 9.0000 EA MECH FURNACE <=100K 9.00 1.00 9.0000 EA MECH B/C <=3HP/100K BTU 9.00 ---------------------------------------------------------------------------- Special Notes and Comments REPLACE HEAT PUMP,FURNACE, CONDENSING UNIT 17.50 SEER 2007 CODES. ---------------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged -------------------- Paid Credited -------------------- Due ----------------- Permit Fee Total 33.00 00 .00 33.00 Plan Check Total 8.25 .00 .00 8.25 Other Fee Total 1.00 .00 .00 1.00 Grand Total 42.25 .00 .00 42.25 LQPERMIT HARVEY, MARY System: #1 Sit!Address: 54-415 En orcementAgenc : Date. 9/8/2010 Permit.#: AVE. MARTINEZ, LA QUINTA, CA 92253 Cify of'La Quinfa Conditioned Floor Equipment e' List Minimum. Efftcienc Duct insulation requirement Area Tierrnostat Packaged Unit ® Furnace 11 AFUE ❑COP Over 40 ft of ducts added or ®Setback. ® Indoor Coil ® SEER 17.50 ® HSPF 9.25 replaced in unconditioned space ❑ R 6 (CZ 10-13) Served by system sf (If not aheady, present, must be ® CondensingUnit ® EER 11 Resistance ❑ R 8 (CZ installed) ❑ Other .1.4-15) 1 1. Equipment Type: Choose. the equipment being installed; if more.than one system, use another CF -IR -ALT -HVAC for each system. 2. Mbdinum. Equipment Efficiencies:, 13 SEER, 78% AFUE, 7.7HSPF for typical residential systems. HERS VERIFICATION SUMMARY Listed below are four HVAC.alteration Options. The installer decides what work is.being done and picks one 6f -the appropriate Options: '.Each Option lists the HERS measures that must. be conducted. A copy of the formsshall 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 conVleltdby the installer. The inspector. also verifies,that.each appropriate CF -6R and registered C.F4R forms (no hand filled CF-4R:s allowed) are filled out and signed. Beginning "October 1, -20111 a registered co of the CF -1R and CF -6R shalt also be on site for final, inspection. ®1.11VAC Changeout 'Required Forms: ® All HVAC Equipment replaced CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH- 25 -HERS CF4R forms: MECH- 21 and. for split systems) MECH-25 ® Condenser Coil and /or ® Indoor. Coil and /or CF -6R forms: MECH-2I-HERS and (for split systems) MECH- 25 -HERS ® Furnace CF -4R forms: MECH- 21 and (for split systems) 'MECH-25 .For Split -Systems: Duct leakage < 15 percent;. RC, CCA > 300 CFM/ton(Minimum Asir Flow Requirement), TMAH For Packaged Units: Duct leakage <:I S percent Exempted from duct. leakage testing if:' ❑ 1. Duct system was documented to have been previously sealed and confirmed through HERS verification, or 0 2. Duct systems with less than 40 linear feet in unconditioned space, or 113. Eki-Wng duct systemsare constructed, insulated or sealed with'asbestos ❑ 2. New HVA ,S stern Required Forms: ❑ Cut in or.Changeout with new CF -6R forms: MECH-04, MECH-20-HBRS,and.(for split systems) MECH 22-HERS,:and'MECH=254MM ducts: (all new ducting and all CP -4R forms: MECH 20-, and (foi split systerns)MECH-22, and MECH 25 new equipment) `For Split Systems: Duct leakage < 6 pereent;.RC, CCA.> 350 CFM/ton, FWD, TMAH, STMS,and.either RSPF1 or PSPP. For Packaged Units: Duct. leakage <kpercent ❑ 3. New Ducts 'with/or. without Replacement Required Forms: ❑ Includes replacing: or installing all new ducting CF -6.R forms: 1N1ECH-04;.MECH40-HERS;and (for split systems) MECH-25=HERS.. and/oroutdobr condensing unit and/orindoor coil CF -4R forms: MECH-20 and (for split systems),KCH-25 and/or furnace. No or some equipment changed. For Split,Systemst Duct leakage < 6 percent, RC, CCA > 300 CFM/ton, TMAii .For Packaged Units: Duct leaks e < 6 Oercent. 114. New Duc ' over 46 feet R wired Forms: ❑ Includes adding or replacing more than 40 _ forms: MECH 04, MECH-2I-HERS CF -4R forms: MECH-21 linear feetof duct in,unconditioned space. For split system or packaged units: Ductleakage < 15 percent ❑ EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos. Contractor (Documentation Author's "/Responsible Designer's Declaration Statement)' ® I certify that this Certificate of Compliance documentation.is accurate and complete.. ® 1 am eligible under Division 3 of the California Business and .Professions Code to accept responsibility for the design identified on this Certificate of Compliance. ® I certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title,24, Parts 1 and 6 of the California Code of Regulations. ® The design featuros:identified on this Certificate of Compliance are consistent with: the information documented on other applicable compliance forms, worksheets, calculations, lans'and s ecifications submitted tathe enforcement agency for, roval with the a lication. Name: KARL BROWN Signature. ` Company: Palm Desert Air Conditioning & Heating Company Date: 9/8/2010 Address: 42-081 Beacon Hill Licrose: 374937 City/State/zip: Palm Desert, CA 92211 phone: (760) 346-0677 2008 Residential Compliance Forms March 2016 P.O. Box 1504 - 78-495,Calle Tampico, - La Quinta, California 92211 Tel: .(760) 777-7012. - Fax: (760) 777-7112 Website: wwwla=Quinta.Org - Email: Building@La-Quinta.Org levo rn ° MM cO, DESERT —. 1.81n #: Permit #: ji2138u 11ding.Permit Application & Tracking, Sheet Project Address: 54-415 AVE. MARTINEZ Owner's Name: HARVEY, MARY A.P. Number:. Address: 54-415 AVE. MARTINEZ Legal Description: City, State, Zip: LA QUINTA, CA 92253 Contractor-* Palm Desert Air Conditioning & Heating Company Telephone: (760) 207-6123 .Address: 42-081 Beacon Hill Project Description: City, State, Zip: Palm Desert, CA 92211 C, 4,0 Telephone No.:. (760) 346-0677 State: Lic. #: 374937 City1ic- #: 100886 .AirchJEngr./Designer7 Address: City,,State, Zip: Telephone No.: Construction Type: Occupancy: State:1ic-M, R:Project Type: 0. New - 0:.Add'n - 0 Alter - 0 Repair- 13 Demd Name:ofContact- Person: KARL BROWN Sq. Ft.t # Stories: # Units: Contact Tel6phone.No.:. (760)346-0677 Estimated Value of Project $7,751.00 APPLICANT".. DO NOT M®RE BELOW THIS LINE Submittal Req?d Recd Tracking Permit Fee's Plan Sets Plan Check Submitted Item Amount. structwal Calds.- Reviewed, Ready f6r Corrections Plan Check Deposit Truss Cales. Called.Contact Person Plan Check Balance Title 24 Calics. Plans Picked'Up Construction Flood Plain. Plan 'Plans Resubmitted Mechanical Grading Plan 2"dRevlew, Readyfor Corrections Elect6cal Subbohtr6d6r- List Gaffed -Contact Person Plumbing Grant Deed Plans Picked Up H.0A..A0pro.val Plans: Resubmitted Grading IN HOUSE 3'd Review, Ready for Corrections Developer Impact Fee Planning Approval :Called, Contact Person A.I.P.P. Pub. Works Appe-1 I Date of Permit Issue School, Fees Total Permit Fee's Shh " Iffied' Ereseri dve Certificate of Cont liance::2008 'Residential HVAC Alterations CF=IR-ALT=HVAC: 1. ClIm' ate Zones:*.to 15, HARVEY, MARY System: #1 Site Address: Enforcement Agenc : Date: Permit #: 54-41°5 AVE. MARTINEZ, LA QUINTA, CA 92253 City of La QuiM 9/8/2010 Conditioned Floor .Equipment T. er List: Minimum,Efficienc.2 Ductinsulationrequirement Area Thermostat Packaged Unit ® ❑ AFUE ❑COP Over 40 ft of ducts added or ®-Setback .Furnace ® Indoor Coil ® SEER 17.50 ® HSPF 9 25 replaced Z unconditioned space Served by system ® Condensing Unit ® EER 12.50 ❑ Resistance ❑ R. 6 "(CZ 10-13) ❑ R g (CZ 14-15) sf present, present, must be inu t installed) ❑ Other ]—Equipment Tyj;e: Choose the equipment being installed; irmore than one system, use another CF-/R-ALT.-FIVACfor each system. 2. Minimum Equipment•Efciencies: 13 SEER, 78%AFUE, 7.7HSPFfar typical residential systems. HERS VERIFICATION SUMMARY Listed below are four.HVAC.alteration Options. The installer decides what work is being done anal picksone ofthe appropriate Options. 'Each Option lists the HERS measures that must be conducted. A copy of the;forms shallbe 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-thateach appropriate CF -6R and registered CF -4R forms (no hand filled CF-4Rs allowed) are filled out and signed. Beginning October 1, 2010, a registered copy of the CF -1R and CF -6R shall also be on site for final inspection. ®1. HVAC Changeout Required Forms: ® All HVAC Equipment replaced CF -.6R forms: MECH-04, (MECH-2.I -HERS and (for split systems) MECH- 25 -HERS CF -4R forms: MECH- 21and fors lits stems MECH-25 ®Condenser Coil and /or ® Indoor Coil and/or CF -6R forms: :MECH-21-HERS and (for split systems) MECH- 25 -HERS ®.Pomace CF-4Rforms: 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 < IS percent £ , Exempted from duct leakage testing if - 0 ❑ l..Duct system was documented to have been previously seated 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 112. New HVAC'System Required ,Forms: ❑ Cut in or Changeout with new CF -6:R forms: MECH-04, MECH-20-H.ERS,and (for split systems) MECH=22-HERS, and MECH-25-HERS ducts: (all new ducting and all CF -4R forms: MECH 20-, and (for split. systems)M:ECH-22, and MECH 25 .new equipment) For Split Systems: Ductleakage < 6 percent; RC, CCA > 350 CFM/ton, FWD, T.MAH,. STM:S, and either HSPP or PSP.P, For Packaged Units: Duct leakage < 6 percent ❑ 3. New:Ducts with/or without 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 coil CF4R forms: MECH-20 and (for split systems) MECH-25 and/or. furnace. No or some equipment changed. For Split Systems: Duct leakage < 6percent,. RC, CCA >_ 300 CFM/ton, TMAH For Packa ed Units: Duct.leaka e < 6 percent 114. New Ducting over 40 feet Required Forms: ❑ Includes adding or replacing more than 40 linear..feet of ductin,unconditioned space. CF -6R forms: MECH-04, MECH-21-HERS CF -4R forms: MECH-21 For split system or packaged units: Duct leakage < 1.5 percent 13EXCEPTION: Existing duct systems constructed, insulated or scaled with asbestos. Contractor (Documentation Author's /Responsible Designer's Declaration Statement) ® I certify that this Certificate of Compliance documentation is accurate and complete. ® I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of Compliance. ® I certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform tothe requirements of Title 24, Parts I: and 6 of the California Code of Regulations. ® The design-katirres:identified on this Certificate of Compliance arc consistent with the information documented on other applicable compliance forms, worksho cts,. calculations„ laps andspecifications submitted to the enforcement agency for approval with the c . ' a lication. Name: KARL BROWN Signature: Company: Palm Desert Air Conditioning & Heating Company Date: 9/8/2010 Address: 42-081 Beacon Hill License: 374937 City/State/zip: Palm Desert, CA 92211 `Phone: (760) 346-0677 '2008 Residential'Compliance.Fornts March 2010 Installation Certificate CF-6R-MECH 21 -HERS Duct Leakage Test — Existing Duct System Page 1..of 2 Site Address: Enforcement Agency: Permit Number: 54-415 AVE. MARTINEZ, LA QUINTA, CA 92253 City of La Quinta 1 10-873 Enter-thebuct System Name or Identification Number: #1 Enterahe Duct`Sysfem Lotatton or Area=Served;' ,/ NOTE: Submit one Installation Certificate for each duct system that must demonstrate compliance in the dwellin nuef Leakaap niannnsfir Tpsf — F4icfinn mint Svatom fifOptiorrl: Measueed:leakage.less1han 15% of Fan Airflow, Eft Option 2: Measured leakage to outside less than 10% of Fan Airflow. ❑ Option 3: Reduced leakage by 60% or more, and conduct smoke test.to seal all accessible leaks. ❑ Option 4: Fix,all.accessible leaks using smoke test, and HERS rater must verify. Determine nominal Fan Airflow using one of the following three calculation methods. Cooling, system method: Size of condenser in Tons — x 400 = boo CFM. EI H,eating-system method: 21.7 x Heating Output Capacity (Btuh/k) = CFM. ❑ Measured system.airflow using RA3.3 airflow test procedures: CFM. Option 1 used then: 1 Allowed .leakage = Fan Airflow x.15= CFM.`.3 Actual leakage = CFM i 6 ) Fan Airflow x 100 = 1 1 O/0 .1 Pass if Actual Leakage is less than Allowed Leakage. Pass ❑ Fail Option 2 used`then: 2' Allowed leakage = Fan Airflow X.10 = CFM. Actual leakage= CFM + Fan Airflow x 100 = % Pass if Actual Leakage to outside is less than Allowed Leakage. ❑ Pass ❑ Fail Option 3 used then: Initial leakage prior to start of work: CFM. 3 Final leakage after sealing all accessible leaks using smoke test= CFM: Initial leakage -.Final leakage =.leakage reduction CFM. Leakage reduction _ Initial leakage x 100 = Pass if%z:60%. ❑ Pass ❑ Fail Option used'then: 4 All accessible leaks repaired using smoke test. HERS rater must verify (no sampling). Pass if all accessible leaks have been sealed using Smoke Test. ❑ Pass Fall Registration Numbee: Registration Date &'Time:. HERS Provider: 2008 Residential .Compliance forms PDAC January: 2Q1 Installation Certificate. CIF -SR-MECH-21HERS., Duct Leakage Test:- Existing Duct System Page 2 cf 2 Site Address.: Enforcement Agency: Permit Number: 54-415 AVE. MARTINEZ, LA QUINTA, CA 92253 City of La Quinta 10-873 HVAC S: stems-- HeatIn Palm Desert Air Conditioning & Heating Company Equipment Type Manufacturer Model Number AFUE HSPF Load Capacity AIR HANDLER AMANA AEPF426016 Is this` installation monitored by a Third Party Quality 9.25 60,000 60,000 HVAC Systems - Cooling: Equipment Type Manufacturer Model Number SEER EER Load Capacity HP CONDENSER AMANA ASZ180481 17.50 12.50 48,000 48,000 Declaration Statement S 1 certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. S. 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). S 1 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. S 1 understand that a HERS rater will check the installation to verify compliance, and that that if such checking identifies defects, I am required to take corrective action at my expense. I' understand that Energy Commission and HERS provider representatives,will also perform quality assurance checking of installations, including those approved as.part of a sample group but not checked by a HERS rater, and if those installations fail to meet the requirement's of such quality assurance'checkirig, the required corrective, action and additional checking/testing of other installations in'that HERS sample group will be performed at my expense. S 1 reviewed a copy of the Certificate of Compliance (CF -1 R) form approved by the enforcement agency that identifies the specific -requirements for`the installation. I certify that the requirements detailed on the CF -1 R that apply to the installation have been met. S 1 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 availableto 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- bu'ilder provides to the building owner at occupancy. I wilt 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: Palm Desert Air Conditioning & Heating Company Responsible Person's Name: _ nsibe n sign re OLMEDA, ANGEL CSLB:License: Date-Sig'ned: -PosibTn /title: 374937 9/8/2010 INSTALLER Is this` installation monitored by a Third Party Quality Name of TCQCP: Control, Program (TPQCP): ❑ Yes S No 'Registration Nombee- Registration Date & Time: HERS Pto4ider: 2008 Resideritial..Complian,ce Forms PDAC-January.201F CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4111-MECH-21 Duct Leakage Test — Existing Duct System (Page 1 of 2) Site Address: 54-415 Ave. Martinez, La Quinta CA 92253 (System Enforcement Agency: Permit Number: 1) City of La Quinta 10-873 Enter the Dud System Name or Identification/Tag: Enter the Dud System Location or Area Served: 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. i-1 1. Measured leakage less than 15% of fan Flow v 2. Measured leakage to outside less than 10% of Fan Flow rl 3. Reduce leakage by 60% and conduct smoke and fix all leaks 4. Fix all accessible leaks using smoke and HERS rater verify Note: (One of Options 1, 2, or 3 must be attempted„before utilizing Option 4.) Determine nominal Fan Flow using one of the following three calculation methods. ✓ U Cooling systern method: Size of condenser in Tons _ x 400 = _ CFM %0'0 Heating system method: 21.7 x _ Output Capacity in Thousands of Btu/hr = _ CFM ✓ G Measured system airflow using RA3.3 airflow test procedures: _ CFM Option 1 used then: 1 Allowed leakage = Fan Flow_ x 0.15 = _ CFM Actual Leakage = _ CFM Pass if Leakage Actual is less than Allowed n Pass r Fail Option 2 used then: 2 Allowed leakage = Fan Flow_ x 0.10 = _ CFM Actual Leakage to outside = _ CFM Pass if Leakage Actual is less than Allowed L7 Pass sj Fail Option.3 used then: Initial leakage prior to start of work = _ CFM Final leakage after sealing all accessible leaks using smoke test = _ CFM 3 Initial leakage _ - Final leakage _ = Leakage reduction _ CFM ((Leakage reduction _/ Initial leakage 1 x 100% _ % Reduction Pass if % Reduction > 60% Pass i Fail Option 4 used then: 4 All accessible leaks repaired using smoke. HERS rater must verify (No sampling). No smoke allowed to leak from system. Including ducts, plenums, air handler and door panel. Pass if all accessible leaks have been repaired using smoke Pass Fail Reg: 210-A0017485A-000000000-M21A Registration Date/Time: 2010/09/27 17:35:54 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-21 Duct Leakage Test - Existing Duct System (Page 2 of 2) Site Address: 54-415 Ave. Martinez, La Quinta CA 92253 (System Enforcement Agency: Permit Number: 1) City of La Quinta 10-873 F] Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off during duct leakage testing. CFI OA ducts that utilize controlled motorized dampers, that open only when OA ventilation is required to meet ASHRAE Standard 62.2, and close when OA ventilation is not required, may be configured to the closed position during duet leakage testing. C-1 All supply and return register boots must be sealed to the drywall if smoke test is utilized for compliance - applies to duct leakage compliance option 3 (leakage reduction by 60%) and option 4 (fix all accessible leaks) described above. U New duct installations cannot utilize building cavities as plenums or platform returns in lieu of ducts. D Mastic and draw bands must be used in combination with cloth backed rubber adhesive duct tape to seal leaks at all new duct connections DECLARATION STATEMENT • I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct.. • I am the certified HERS rater who performed the verification services identified and reported on this certificate (responsible rater). • The installed feature, material, component, or manufactured device requiring HERS verification that is identified on this certificate (the installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified on the Certificate(s) of Compliance (CF -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) PALM DESERT AIR CONDITIONING CO INC Responsible Person's Name: CSLB License: Angel Olmeda 1374937 HERS Provider Data Registry Information Sample Group # (if applicable): 171922 tested/verified dwelling —2—not-tested/verified dwelling in a HERS sample group HERS Rater Information Ca10ERTS Certificate # CCI -1798512500 HERS Rater Company Name: Air Experts Air Conditioning Responsible Rater's Name: Responsible Rater's Signature: Paul Van Vlymen Paul Van Vlyrmn Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 8/31/2010 CC2004367 MGH: a1u-Huu11snow-UUUUUUUUU-M21A Registration Date/Time: 2010/09/27 17:35:54 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 Installation Certificate CF-6R-MECH-25-HERS Refrigerant Charge Verification — Standard Measurement Procedure Page I- of 5 Site Address: Enforcement Agency: Permit Number: 54-415 AVE. MARTINEZ, LA QUINTA, CA 92253 City of La Quinta 10-873 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 systerns.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. Enter the Duct System Name or Identification Number: !EntBr the Duct System Location _or AreaServeO 10 NOTE: Submit one. Installation Certificate for each ducts stem that must demonstrate compliance in the dwelling. TMAH - Access. Holes in Supply and Return Plenums of Air Handier 1 WYes ❑ 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 m.m) 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. - Sensor on the Evaporator Coil Select one option. ❑ N/A 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 The sensor measures the saturation temperature of the coil within 1.3° F. Yes to.3, 4 and 5 is a pass. Select one option. I&A ❑ Pass ❑.Fail STMS Sensor on the Condenser Coil 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 0 Yes ❑ No The sensor measures the saturation temperature of'the coil within 1:3° F. Yes to 6, 7 and 8 is a pass. Select one option. N/A ❑ Pass '❑ Fail Registration Number. Registration Date & Time: HERS Provider: 2008'Residential Compliance Forms PDAC January 2010 'Installation Certificate CF-6R-MECH-25-HERS Refrigerant Charge Verification — Standard Measurement Procedure Page 2 of 5 Site :Address: Enforcement Agency: Permit Number: 54-415 AVE. MARTINEZ, LA QUINTA, CA 92253 City of La Quinta 10-873 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. - it outgoor air cry -bulb iS`55' -t- or oeiow, the instaner must use the Aitemate Guar a Measurement Procedure. Enter the Duct System Name or Identification Number: I #1 Enter the Duct System Location or Area Served: inn qv-qfPnnq Outdoor Unit Manufacturer: AMANA Outdoor Unit Model Number: ASZ180481 Outdoor Unit Serial Number: 0911020037 Outdoor Unit Nominal Cooling Capacity (Btu/h): 48,000 Date of Verification: 9/8/2010 Calibration of Diagnostic Instruments Must be re -calibrated month) Date of Refrigerant Gauge Calibration: 9/1/2010 Date of Thermocouple Calibration: 9/1/2010 Measured TemperaturesPIP) Supply (evaporator leaving) air dry-bulb temperature (TsuPPi_Y, DB): 1 60 Return (evaporator entering) air dry-bulb temperature (TRETURN, DB): Return (evaporator entering) air wet -bulb temperature (TRETURN, WB): o Evaporator saturation temperature (TEVAPORATOR, SAT): L Condensersaturation temperature (TcONDENSOR, SAT): n CR Suction line temperature (TSUCTION): Liquid Line Temperature (TLIQUio): o Condenser (entering) air dry-bulb temperature (TcoNDENSER, DB): Registration Number. Registration Date B Time: HERS Provider: 2008 Residential :Compliance Forms PDAC January 2010 Installation Certificate C04*-MEdH--25.HRRS;- Refriger4ritChArgi) Verification StdndardMeasurement Proc'ddure :Page 3'of'5, SIWAddtess: Enforcement Agency: Permit Number: 4 54-415 AVE. MARTINEZ, LA QUINTA, CA 92253 City of La Quinta10 1 -873 .Enter the Duct System -Name or Identification. Number: Verification. The temperat ure split method is specified in Reference Residential Appendix., R -A3.2. Enter the auct Sys tem Location or Area,S'Orved: RRinimaim . Temperature split Method Calculations for determining Minimum Airflow Requirement for Refrigerant Charge Verification. The temperat ure split method is specified in Reference Residential Appendix., R -A3.2. Calculate: Actual Temperature Split:, [TkIETURN, DB --: tSUPPLY, DB] r. aG Target Temperature Split from Table RA3.2-3: [Using TRETURN, WB and TRE -r -URN, DB] Calculate Difference: (Actual Temperature -Split— — Target Temperature Split] Passesif difference is ±.3* For, -upon remeasurement, if _15"Pass between -3°F arid -100*F L) Fail Note: Temperature Split Method Calculation is not necessary if actual Cooling Coil Airflow is verified using ono of the measurement procedures specirled in Reference Residential Appendix RA3,3. ff actual co6lihg coil a'i-itl6w is coil measur6d, the value, Must,69 equal to or greater -than the Calculated Minirhurn Airflow Requirement in t66 table below. Calculated Minimum Alifflow'Requirement.(CF11111) = Nominal Cooling Capacity (Ton)*X 300 (CFM/Ton) talculated-Minimurn Airflow,Reqvirement (CFM): Measured Airflow usi I 3.3Prdcedures (CFM): 'airflo ,-'Ih Calculated. Passes ifneasured' 'irflow Calculated minimum airflow t2eq uifement. 0 Pass 0 Fail Superheat Charge Method Calculat 10 fixed orifte:metering.device systems, Ca.1dulate,.Actual Superheat [TSU,CTION-- TEVAPORATOR, SAT] Target Superheat from Table RA3;2-2: [Using TRETURIN, WBian,d TCONPENSER, DB Calculate Difference: [Actual'5,up-6,rheat — Target,:Sup6r a Ztj Passes:if diff6r ,ence is ±-6- F/ r Refrigerant Charge Verifit 13 Pass This procedure is required4o be used for 13 fail Registitifidn NlUrnbde' Registration Date &.7rine: HERS Provider: -2066:R dential,'Compbrice.,Forms :PDAC January 2010, Installation;Certificate CF=61k-MECH-25=HERS: RefrigerantCharge Verification —Standard Measurement Procedure Page 4'of'S' Site Address: Enforcement Agency: Permit Number: 54-415 AVE. MARTINEZ, LA QUINTA, CA 92253 City of La Quinta 10-873 I Enter the Duct System Name or Identification Number:I #1 I I Enter the Duct System Location.or Area Served: I 1 1 (-->:I 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. Calculate: Actual Subcooling: [TCONDENSER, SAT— TUQUID] G Target,Subcooiing specked by manufacturer: Calculate. Difference: [Actual Subcooling - Target Subcooling] Q Passes if difference is t3° F gpass D 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. Calculate: Actual Superheat: [TSUCTION — TEVAPORATOR; SAT] Enter allowable superheat. range from- manufacturer's specifications (or use. range 4°,F 25°F if manufacturer's specification is not available). Passes if actual superheat is within the allowable superheat, range. C> - D,5 0 "Fail ;Registration Number Registration Date & Time: HERS Provider: 2008' Resideritia[Complian.ce Forms P.DAC Janua 2010` .. Installation Certificate CF-SR-MECH-25-HERS3i Refrigerant Charge'Verifcation — Standard Measurement Procedure Page *5 of"5,,'.' Site Address: Enforcement Agency: Permit Number: :54-415 AVE. MARTINEZ, LA QUINTA, CA 92253 1 City of La Quinta 10-873 Standard Charge,Measurement Summary: System shall pass both: refrigerant charge criteria, metering device criteria (if_apolicable)i and mihimurri 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. Enter the Duct System.Name or Identification Number: I # System meets all refrigerant charge and airflow requirements:. Pass D Fail Declaration Statement ..0 I"certify under penalty of perjury, under the laws of the State of California, the information provided on this form, is true and correct. ® Fam eligible under Division 3 of the Business and.Professions-Code to accept responsibility f6rconstru.ction, oran authorized representative of'the person responsible for construction (responsible per§on). - 19 I .certifyahatthe installed features, materials, components, or manufactured devices identifiedon this certtficate (the` installation) conforms: to all applicable, codes and regulations, and.the installation is consistent with the plans and specificationsapproved by the enforcement agency. ® 1'.understand that a HERS rater will check the installation to verify compliance., and that that if such checking i4pritifies defects, I am required to take corrective action at my expense. I understand that Energy Commission and HERS provider representatives will also perform. quality assurance checking of installations, including those'approved as part of a sample group but not checked by a' HERS rater, and if those installations fail to meet.the requirements;.of such quality assurance checking, the .required corrective action and additional checking/testing of other installations in that. HERS,sample.group will be performed at:my expense. ®:.I reviewed -'a copy of the:Certificate of Compliance (CF -1 R) form approved by the enforcement agency that identifies thespecific requirements for the installation. I certify that therequirements.detailed on the CF -1 R hat apply to the installatim have been met. ® 1 will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with -the, building permits) issued for the; building,:and made available to the enforcement agency, for all. applicable inspectio.ns. -1 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:. Palmbesert Air Conditioning & Heating Company Responsible Persori'sName;„ ,.onslble4 b ' xSignatu OLMEDA, ANGEL CSL:B,Iicense: Date Signed: / Title. 374937 9/8/2010 INSTALLER Is thisinstallatlon monitored by a Third Party Quality Name of TCQCP: Control.Program `(TPQCP): ❑ Yes ®No Registration Number. Registration Date '& Time` HERS Provider: 2008 Residential :Compliance forms PDAC Januar 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4111-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 -of 5) Site Address: Enforcement Agency: Permit Number: 54-415 Ave. Martinez, La Quinta CA 92253 City of La.Quinta 10-873 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 Location or Area Served 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 ✓ I Pass ✓ L Fail STMS - Sensor on the Evaporator Coil System Name or Identification/Tag The sensor is factory installed, or field installed according to manufacturer's 3 Q 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 4 ;) Yes D 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 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. Otherwise enter Pass or Fail ,i 0 N/A ✓ ; " Pass ✓ j Fail STMS - Sensor on the Condenser Coil System Name or Identification/Tag The sensor is factory installed, or field installed according to manufacturer's 6 Li Yes U 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 U Yes L 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 M Yes rj 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. Otherwise enter Pass or Fail ✓ j N/A ✓ Pass ✓ I..r Fail Reg: 210-A0017485A-000000000-M25A Registration Date/Time: 2010/09/27 17:37:43 HERS Provider: C'a10ERTS, Inc. 2008 Residential Compliance Forms March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5) Site Address: Enforcement Agency: Permit Number: 54-415 Ave. Martinez, La Quinta CA 92253 City of La Quinta 10-873 Standard Charge Measurement Procedure (for use if outdoor air dry-bulb is above SSOF) Procedures for determining Refrigerant Charge using the Standard Charge Measurement Procedure are available in Reference Residential Appendix RA3.2. As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional form(s) for any additional systems In the dwelling as applicable. • The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure. • The system must meet minimum airflow requirements as prerequisite for a valid refrigerant charge test. • If outdoor air dry-bulb Is 55°F or below, the installer must use the Alternate Charge Measurement Procedure. Space Conditioning Systems System Name or Identification/Tag System Location or Area Served Outdoor Unit Serial # Outdoor Unit Make Outdoor Unit Model Nominal Cooling Capacity Btu/hr Date of Verification Calibration of niannnc+i, Date of Refrigerant Gauge Calibration (must be re -calibrated monthly) Date of Thermocouple Calibration (must be re -calibrated monthly) Meaeurad Tamn-11—v— loci System Name or Identification/Tag 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 (Tretum, 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: 210-A0017485A-000000000-M25A Registration Date/Time: 2010/09/27 17:37:43 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: 54-415 Ave. Martinez, La Quinta CA 92253 1 City of La Quinta 10-873 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 = Tret urn, db - Tsupply, db Target Temperature Split from Table RA3.2-3 using Tretum, wb and Treturn, db Calculate difference: Actual Temperature Split - Target Temperature Split = Passes if difference is between -4°F and +40F 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. 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 -60F and +6°F Enter Pass or Fail Reg: 210-A0017485A-000000000-M25A Registration Date/Time: 2010/09/27 17:37:43 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-411-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5) Site Address: Enforcement Agency: Permit Number: 54-415 Ave. Martinez, La Quinta CA 92253 City of La Quinta 10-873 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 = passes if difference is between d +4°F r-V Enter Pass or Fall 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 ` . ,uc Reg: 210-A0017485A-000000000-M25A Registration Date/Time: 2010/09/27 17:37:43 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5) Site Address:. Enforcement Agency: Permit Number: 54-415 Ave. Martinez, La Quinta CA 92253 1 City of La Quint a 10-873 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 Angel Olmeda 374937 HERS Provider Data Registry Information Sample Group # (if applicable): 171922 System meets all refrigerant charge and airflow not-tested/verified dwelling in la HERS sample group requirements. HERS Rater Company Name: Air Experts Air Conditioning Responsible Rater's Name: Responsible Rater's Signature: Enter Pass or Fail Paul Van Vlyn= Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 8/31/2010 CC2004367 I DECLARATION STATEMENT . I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. • I am 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 Certificates) (CF -611), signed and submitted by the person(s) responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -111) approved by the enforcement aaencv. Builder or Installer Information as shown on the Installation Certificate (CF -6111) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) PALM DESERT AIR CONDITIONING CO INC Responsible Person's Name: CSLB License: Angel Olmeda 374937 HERS Provider Data Registry Information Sample Group # (if applicable): 171922 ❑ tested/verified dwelling not-tested/verified dwelling in la HERS sample group HERS Rater Information Ca10ERTS Certificate # CC1-1798512500 HERS Rater Company Name: Air Experts Air Conditioning Responsible Rater's Name: Responsible Rater's Signature: Paul Van Vlymen Paul Van Vlyn= Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 8/31/2010 CC2004367 Reg: 210-A0017485A-000000000-M25A Registration Date/Time: 2010/09/27 17:37:43 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010