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MECH (12-1146)*'P.O. BOX 1504 'y 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application description Property Zoning: Application valuation: 12-00001146 53220 AVENIDA MENDOZA 774-063-011-14 -000000- MECHANICAL COVE'RESIDENTIAL 5000 Tilif BUILDING & SAFETY DEPARTMENT Architect or Engineer: alp BUILDING PERMIT LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm under penalty of perjury that I am ' ensed u er provisions of Chapter 9 (commencing with Section 70 01 of ivision 3 of the Business an Professio s Code, and my License is in full force and effect. Licens ss: �0 License No.: 725283 ate: /� ontractor: WNER-BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: (_ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). (_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed - pursuant to the Contractors' State License Law.). (_ 1 I am exempt under Sec. , B.&P.C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: Lender's Address: PJA LQPERMIT EZ- - - Owner: CARRILLO GILBERT 53220 AVENIDA MENDOZA LA QUINTA, CA 92253 Contractor: ' AIR EXPERTS AIR CONDITI PO BOX 94 LA QUINTA, CA 92247 (760)777-1724 Lic. No.: 725283 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 9/28/12 WORKER'S COMPENSATION DECLARATION hereby affirm under penalty of perjury one of the following: declarations: _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by'Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier NORGUARD INS Policy Number PAWC334856 I certify that, in the performance of trk for which this permit is issued, I shall not employ any person in any manner so as t e-ome s ject to the workers' compensation laws of California, an agree that, if I should b oma sub' t to the workers' compensation provisions of Section - 3 0 of the Labor Code, I all fo ith comply with those provisions. aD te: �� pplicanC WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000)• IN ADDITION TO THE COST OF COMPENSATION; DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. 1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application, the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state th the abo nformation is correct. I agree to comply with all city d coy y or finances a state laws relating buil ' construction, and hereby authorize representatives his u/s�yt�-to nter upo the above-mentioned erty for inspection purposes. Date: . `'v gnature (Applicant or Agerit): f Application Number . . . . . 12-00001146• Permit . . . MECHANICAL Additional desc . Permit Fee . . . . 40.50 Plan Check Fee 10.13 Issue Date . . . . Valuation . . . . 0 Expiration Date 3/27/13 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 HVAC CHANGE -OUT: REPLACE PACKAGE HEAT PUMP UNIT. 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 -IR -ALT -HVAC Climate Zones 10 - 15 Site Address: Enforcement Agency: Date: Permit #: 53220 Avenida Mendoza La Quinta, CA 92253 City of La Quinta Sep 28, 2012 Duct insulation Conditioned Floor Equipment Typel List Minimum Efficiency2 requirement Area Thermostat ® Package Unit ❑ Furnace [3 Indoor Coil ❑ AFUE ® SEER 13.0 ❑ COP13 ® HSPF 7.7 R 6 (CZ 10-13) Served Served by system b ® Setback If not already present, must be [3 Condensing Unit ❑ EER [3 Resistance R g CZ 14-15)Resistance 16 installed) ❑ Other 1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -IR -ALT -HVAC for each system. 2. Minimum Equipment Efficiencies: 13 SEER, 78% AFUE, 7.7HSPF for typical residential systems. HERS VERIFICATION SUMMARY Listed below are FOUR HVAC alteration Options. The installer decides what work is being done and picks one of the appropriate Options. Each Option lists the HERS measures that must be conducted. A copy of the forms shall be left on site for final inspection and a copy given to the homeowner. At final, the inspector verifies that the work listed on this form was in fact the work completed by the installer. The inspector also verifies that each appropriate CF -611 and registered CF -411 forms (no hand filled CF-4Rs allowed) are filled out and signed.Beginning October 1, 2010, a registered copy of the CF -111 and CF -611 shall also be on site for final inspection. ® 1. HVAC Changeout Required Forms: • All HVAC Equipment CF -611 forms: MECH-04, MECH-2I-HERS BRd (c„- splik ..,,.-t,.ms) 04EGH 25 -WEBS replaced CF -4R forms: MECH-21 BRd ff ff plat . .e.f..MS) P4C-GH LI I • Condenser Coil and /or CF -6R forms: MECH-04, MECH-2I-HERS »d (f^- Split systems) MKW-25-WEBS • Indoor Coil and /or CF -4R forms: MECH-21 and (Fee ...Jit MECH 2 • Furnace systems) For Packaged Units: Duct leakage < 15 percent Exempted from duct leakage testing if: ' ❑ 1. Duct system was documented to have been previously sealed and confirmed through HERS verification, or ❑ 2. Duct systems with less than 40 linear feet in unconditioned space, or ❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos ❑ 4. The;system-will not be Ducted (ie.;Ductless;Mini-Split System)'(Also�Exempt from Refrigerant Charge) ❑ 2. New HVAC System Required Forms: t ) V . Cut in'or Changeout with. '� s ► new ducks: (all new i >f r * CF 611 forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-22=HERS, and MEC , H-25=HERS ducting and all new + j CF -4R forms: MECH720 and (for split systems) MECH-22, and MECH-25 equipment)_lt. _. l ; . _ .+ [ r+1=:. i.�.•. 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/or without Required Forms: Replacement . Includes replacing or installing all new ducting and/or outdoor condensing unit CF -6R forms:'MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS and/or indoor coil and/or furnace. No or some CF -411 forms: MECH-20 and (for split systems) MECH-25 equipment changed. For Split Systems: Duct leakage < 6 percent; RC, CCA >_ 300 CFM/ton, TMAH For Packaged Units: Duct leakage < 6 percent ❑ 4. New Ducting over 40 feet Required Forms: • Includes adding or replacing more than 40 CF -611 forms: MECH-04, MECH-2I-HERS linear feet of dud in unconditioned space. CF -411 forms: MECH-21 For split system or packaged units: Dud leakage < 15 percent ❑ EXCEPTION: Existing dud systems constructed, insulated or sealed with asbestos. Contractor (Documentation Author's /Responsible Designer's Declaration Statement) • I certify that this Certificate of Compliance documentation is accurate and complete. • I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of Compliance. • I certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24, Parts 1 and 6 of the California Code of Regulations. f • The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with the permit application. Name: Lisa Van Vlymen Signature: Lisa Van Vlymen Company: AIR EXPERTS AIR CONDITIONING -HEATING Date: Sep 28, 2012 Address: PO BOX 94 License: 725283 City/State/Zip: LA QUINTA / CA / 92247-0094 Phone: (760) 777-1724 Reg: 212-A0054244A-00000000-0000 Registration Date/Time: 2012/09/28 16:36:52 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms July 2010 i ' Bin. # . r City of La QUinta Building 8i' Sarety Division Permit # ` P.O. Box 1504,78-495 Calle Tampico La.Quinta, CA 92253 -:(760) 777-7012 1 Building Permit -Application and Tracking Sheet Pro'J ect Address: /f�,� , i '• � ��XJGiT- Owner's Name:. A P. Number.Address: S�Z 10 i Legal Description: City, ST, Zip: L4 (�,lA„;J'7 A i Contractor. 1pe TS Telephone: Address: C1f Project Description: City, ST, ZiP: Z,4-0 '-A.' i- i Telephone: Z State Lic. # : 71> City Lic. M. Arch., Engr., Designer. Address: City., ST, Zip: Total Permit Fees Telephone. Construction Type:. Occupancy. State Lic. #:"~ - ' . Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: Sq. Ft.: # Stories: #Units. Telephone # of Contact Person:eA Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE p Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cities.Reviewed, ready for corrections Plan Check Deposit. . Truss Calcs. Called Contact Person Pian Check Balance - i Title 24 Calci. Pians picked up Construction --- — Hood piga plan_ _Plans -resubmitted-.-- — -Mechanical Grading plan 2a° Review, ready for correctionViissue Electrical -- Subcontactor List Called Contact Person Plumbing -- - - Grant Deed Plans picked up S.M.1 H.O.A. Approval Plans resubmitted Grading IN HOUSE:- 'n° Review; ready for correctionslissue Developer Impact Fee Planning Approval. Called Contact Person A.I.P.P. Pub. Wks. Appr ' Date of permit issue School Fees Total Permit Fees _._ f ,�'` ' n �CA�: ? 3 h _ i -.r " ` `.•,` i �. •,/,�tT .. .,'''"fir S. 41 '1: A- 1) City of La Quinta 12-1146 Heating Capacity (kBtu/hr) Package Heat Pump MAYTAG PPH2SD-X48K 1 .7.7 HSPF Attic R-4.2 48 4 Tons _ Type - _ (package INSTALLATION CERTIFICATE !,,, _ CF-6R-MECH-0 Space Conditioning Systems, Ducts and Fans (Page -1 of 2) Site Address: 53220 Avenida Mendoza, La Quinta CA 92253 (System Enforcement Agency: Permit Number: " 1) City of La Quinta 12-1146 Space Conditioning Systems ,F Heating Equipment • Equip Type (package- heat pump) ' CEC Certified Mfr. Name and Model Number ARI Reference Number2 # of Identical Systems Efficiency (AFUE, etc.)1, 3 (>=CF -1R value)4 Duct ' Location (attic, crawl- space, etc.) Duct R -value Heating Load (kBtu/hr) Heating Capacity (kBtu/hr) Package Heat Pump MAYTAG PPH2SD-X48K 1 .7.7 HSPF Attic R-4.2 48 4 Tons _ Type - _ (package ^-' ARI # of and EER) 1,3 (attic, crawl- Cooling Cooling heat CEC Certified Mfr. Name ' Reference Identical' (>=CF -1R space, Duct Load Capacity . pump) and Model Number; Number2 Systems value)4 etc.) R -value (kBtu/hr) (kBtu/hr) Package � Heat 7 rf° ''' = 31 Attic Pump, PPH25D-X48K 2SD-X4 / v� 13 SEER 6 R-4.2 48 4 Tons -1111M GWWVY1/ICIIL . - a 1. If project is new construction, see Footnotes to Standards Table 151-8 and Table 151-C for duct ceiling alternative compliance. I 2. ARI Reference Number can be found by entering the equipment model number. at http://www.aridirectory.orglarilac.php# 3. Listed efficiency on this page must be greater than or equal ( ? ) to the value shown on the CF -11? form. 4. When CF -IR is reference it is also applicable to the CF -1R, CF -IR -AA or CF -IR -ALT , ALL BOXES MUST BE CHECKED TO BE A VALID•FORM ® §110-§113: HVAC equipment is certified by the California Energy Commission. ® §150(h): Heating and/or cooling loads calculated in accordance with ASHRAE, SMACNA, or•ACCA. ® §150(i): Setback Thermostat on all applicable heating and/or cooling systems meet the requirements�of, §112(c). , H §150(j)2: Pipe insulation for cooling system refrigerant suction, chilled water and brine lines meets o minimum requirements of Table 150-B and includes a vapor retardant or is enclosed entirely in conditioned space. 71 Reg: 212-A0054244A-M0400001A-0000 Registration Date/Time: 2012/10/06 19:35:48 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms,' - ! " , August, 2009 Efficiency Duct Equip - ' (SEER Location _ Type - _ (package ^-' ARI # of and EER) 1,3 (attic, crawl- Cooling Cooling heat CEC Certified Mfr. Name ' Reference Identical' (>=CF -1R space, Duct Load Capacity . pump) and Model Number; Number2 Systems value)4 etc.) R -value (kBtu/hr) (kBtu/hr) Package � Heat 7 rf° ''' = 31 Attic Pump, PPH25D-X48K 2SD-X4 / v� 13 SEER 6 R-4.2 48 4 Tons its f ; f 1. If project is new construction, see Footnotes to Standards Table 151-8 and Table 151-C for duct ceiling alternative compliance. I 2. ARI Reference Number can be found by entering the equipment model number. at http://www.aridirectory.orglarilac.php# 3. Listed efficiency on this page must be greater than or equal ( ? ) to the value shown on the CF -11? form. 4. When CF -IR is reference it is also applicable to the CF -1R, CF -IR -AA or CF -IR -ALT , ALL BOXES MUST BE CHECKED TO BE A VALID•FORM ® §110-§113: HVAC equipment is certified by the California Energy Commission. ® §150(h): Heating and/or cooling loads calculated in accordance with ASHRAE, SMACNA, or•ACCA. ® §150(i): Setback Thermostat on all applicable heating and/or cooling systems meet the requirements�of, §112(c). , H §150(j)2: Pipe insulation for cooling system refrigerant suction, chilled water and brine lines meets o minimum requirements of Table 150-B and includes a vapor retardant or is enclosed entirely in conditioned space. 71 Reg: 212-A0054244A-M0400001A-0000 Registration Date/Time: 2012/10/06 19:35:48 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms,' - ! " , August, 2009 INSTALLATION CERTIFICATE CF-6R-MECH-0 Space Conditioning Systems, Ducts and Fans (Page 2 of 2) Site Address: 53220 Avenida Mendoza, La Quinta CA 92253 (System Enforcement Agency: Permit Number: 1) City of La Quinta 12-1146 Ducts and Fans §150(m): Duct and Fans ❑ 1. All air -distribution system ducts and plenums installed, sealed and insulated to meet the requirements of CMC Sections 601, 602, 603, 604, 605 and Standard 6-5; supply -air and return -air ducts and plenums are insulated to a minimum installed level of R-4.2 or enclosed entirely in conditioned space. Openings shall be sealed with mastic, tape or other duct -closure system that meets the applicable requirements of UL 181, UL 181A, or UL 1818 or aerosol sealant that meets the requirements of UL 723. If mastic or tape is used to seal openings greater than 1/4 inch, the combination of mastic and either mesh or tape shall be used; and ❑ 1. Building cavities, support platforms for air handlers, and plenums defined or constructed with materials other than sealed sheet metal, duct board or flexible duct shall not be used for conveying conditioned air. Building cavities and support platforms may contain ducts. Ducts installed in cavities and support platforms shall not be compressed to cause reductions in the cross-sectional area of the d u cts. ❑ 2D. Joints and seams of duct systems and their components shall not be sealed with cloth back - rubber adhesive duct tapes unless such tape is used in combination with mastic and draw bands. ❑ 7. Exhaust fan systems have back draft or automatic dampers. ❑ 8. Gravity ventilating systems serving conditioned space have either automatic or readily accessible, manually operated dampers. ❑ Protection of Insulation. Insulation shall be protected from damage, including that due to sunlight,` moisture, equipment maintenance, and wind. Cellular foam insulation shall be protected as above or painted with a coating that is water retardant and provides shielding from solar radiation that can cause degradation of the material. ❑ 10. Flexible ducts cannot have porouslinner.cores. DECLARATION STATEMENT . I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. . I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized representative of the person responsible for construction (responsible person). . I certify that the installed features, materials, components, or manufactured devices identified on this certificate (the installation) conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the enforcement agency. . I reviewed a copy of the Certificate of Compliance (CF -111) form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF -111 that apply to the installation have been met. . I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occuoancv. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) Air Experts Air Conditioning Responsible Person's Name: Responsible Person's Signature: Paul Van Vlymen Paul Van Vlymen CSLB License: 725283 Date Signed: 10/2/2012 Position With Company (Title): 32 Reg: 212-A0054244A-M0400001A-0000 Registration Date/Time: 2012/10/06 19:35:48 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 1 _ 32 Reg: 212-A0054244A-M0400001A-0000 Registration Date/Time: 2012/10/06 19:35:48 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE ,- - CF 6R MECH 21 HERS Duct Leakage Test — Existing Duct System (Page i of 2) Site Address: 53220 Avenida Mendoza, La Quinta CA 92253 (System Enforcement Agency: Permit Number: 1) City of La Quinta , 12-1146 Enter the Duct System Name or Identification/Tag: System 1 Enter the Duct System Location or Area Served: Whole House Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the dwelling. This installation certificate is required for compliance for alterations and additions in space conditioning systems and duct systems. t� Note: For existing dwellings, a completely new or replacement duct system can also include existing parts of the original duct system (e.g., register boots, air handler, coil, plenums, etc.) if those parts are accessible and they can be sealed. For a completely new or replacement duct system installed in an existing dwelling, use the Installation Certificate titled "Duct Leakage Test - Completely New or Replacement Duct System. Duct Leakage Diagnostic Test - existing duct system Select one compliance method from the following four choices. ❑ 1. Measured leakage less than.15% of fan flow ❑ 2. Measured leakage to outside less than 10% of Fan Flow ❑ 3. Reduce leakage by 60% and conduct smoke and fix all leaks ® 4. Fix all accessible leaks using smoke and HERS rater verify ; Note: (One of Options 1, 2 or 3 must be attempted before utilizing Option Determine nominal Fan Flow using one of the -following three calculation methods.jv 11 F' ✓ ® Cooling system method: Size of�condenser,in Tons 14 'x 400 =1 1600 • CFM ✓ ❑ Heating system m/e�t`hod: 21.71 x 8 Output Capaiycity in Thousands of�Btu/hr — _ CFM , ✓ �I► t , 1 # khiT srlil�lk ❑ Meas, .system airflow using RA3.,3'airflo d est procedures: _ CFM �. (�. Option i used then: •^ - 1 Allowed leakage = Fan Airflow 1600 x 0.15 = 240 CFM '- Actual Leakage= 1346 CFM s Pass if Actual Leakage is less than Allowed leakage. Pass ❑ Fail Option 2 used then: s 2 Allowed leakage = Fan Airflow 1600 x 0.10 = 160 CFM Actual Leakage to outside = _ CFM 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 ` Final leakage after sealing all accessible leaks using smoke test = CFM i+ '- 3 • Initial leakage _ - Final leakage _ = Leakage reduction CFM k'' f ((Leakage reduction _ / Initial leakage x 100% _ /a Reduction Pass if % Reduction >= 60% Pass Fail Option 4 used then: 4 All accessible leaks repaired using smoke test. HERS rater must verify (No Sampling). Pass if all accessible leaks have been repaired using smoke aPass Fail - - f .. 1 - ♦ ' � tet. � � _+.,. - r , y f , ' • w * ' - •. •.. Reg: 212-A0054244A-M2100001A-0000 Registration Date/Time: 2012/10/06 19:49:40 i,HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms + _ March 2010 , INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS Duct Leakage Test - Existing Duct System - (Page 2 of 2) Site Address: 53220 Avenida Mendoza, La Quinta CA 92253 (System Enforcement Agency: I Permit Number: t 1) City of La Quinta 12-1146 ® Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not -be sealed/taped off during duct leakage testing. CFI OA ducts that utilize controlled motorized dampers, that open only when OA ventilation is required to meet ASHRAE Standard 62.2, and close when OA ventilation is not required, may be configured to the closed position during duct leakage testing. xw ® All supplyrand return reg isterboots?'must be�seaied to the drywall if sm oke test. -is utilized forjcompliance - applies fo duct leakage compliance option 3 (leakage reduction.by 60%) and option 4�(fix all accessible leaks) described above. �` w y ® New duct•installations cannot uti ize'building cavities asiplenums)or�platform returns in lieu of ducts.; ®Mastic and draw bands must ,be used in combination with cloth backed rubber adhesive duct"tape to seal leaks at all new duct connections DECLARATION STATEMENT ' . I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. • I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized representative of the person responsible for construction (responsible person). . I certify that the installed features, materials, components, or manufactured devices identified on this"certificate (the installation) conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the enforcement agency. . I understand that a HERS rater will check the installation to verify compliance, and that that if such checking identifies defects, I am required to take corrective action at my expense. I understand that Energy Commission and HERS provider representatives will also perform quality assurance checking of installations, including those approved as part of a sample group but not checked by a HERS rater, and if those installations fail to meet the requirements of such quality assurance checking, the required corrective action and additional checking/testing of other installations in that HERS sample group will be performed at my expense. . I reviewed a copy of the Certificate of Compliance (CF -1R) form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF -111 that apply to the installation have been met. • I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. I will ensure that all Installation Certificates will come from a HERS provider data registry for multiple orientation alternatives• and beoinnino October t 2n1 n_ fnr Al inw-rice rocirianrial hidle nne Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) Air Experts Air Conditioning Responsible Person's Name: Responsible Person's Signature: Paul Van Vlymen Paul Van Vlymen CSLB License: 725283 Date Signed: 10/2/2012 position With Company (Title): Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? 0 Yes p No . Reg: 212-A0054244A-M2100001A-0000 'Registration Date/Time:.2012/10/06.19:49:40 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance'Forms y March 2010 f y y CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-21 Duct Leakage Test — Existing Duct System (Page 1 of 2) Site Address: 53220 Avenida Mendoza, La Quinta CA 92253 (System Enforcement Agency: Permit Number: 1) City of La Quinta 12-1146 Enter the Duct System Name or Identification/Tag: System 1 Enter the Duct System Location or Area Served: Whole House Note: Submit one Installation Certificate. for each duct system that must demonstrate compliance in the dwelling. This installation certificate is required for compliance for alterations and additions in existing dwellings to space conditioning systems and duct systems. Note: For existing dwellings, a completely new or replacement duct system can also include existing parts of the original duct system (e.g., register boots, air handler, coil, plenums, etc.) if those parts are accessible and they can be sealed. For a completely new or replacement duct system installed in an existing dwelling, use the Installation Certificate titled "Duct Leakage Test - Completely New or Replacement Duct System. " Duct Leakage•Diagnostic Test - existing duct system Select one compliance method from the following four choices. ❑ 1. Measured leakage less than 15% of fan flow ' ❑ 2. Measured leakage to outside less than 10% of Fan Flow ❑ 3. Reduce leakage by 60% and conduct smoke and fix all leaks IR 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.),,,y , T Determine nominal Fain Flow using one ofahe following three calculation methods. Or' ( ( ✓ ®Cooling'system method: Size ALondenser in Tons J 4 x 400 =,1 1600 CFM VO HeLngsystem method: 21.7 x Output Capacity in Thousands of Btu/hr = _ CFM ✓ 11Measured system airflow using RA3:3 airflow est procedure : t' CFM, Option 1 used then: a - 1 Allowed leakage = Fan Flow 1600 x 0.15 = 240 CFM r Actual Leakage`= 1346 CFM ! Pass if Leakage Actual is less than Allowed ❑ Pass Fail Option 2 used then: 2 Allowed leakage = Fan Flow ' 1600 x 0.10 = 160 CFM Actual Leakage to outside _ — CFM Pass if Leakage Actual is less than Allowed Pass Fail Option 3 used them, • Initial leakage prior to start of work = CFM Final leakage after sealing all accessible leaks using smoke test = CFM 3 Initial leakage _ - Final leakage _ = Leakage reduction _ CFM - +. ((Leakage reduction _/ Initial leakage x 100% _ % Reduction • Pass if % Reduction >= 60% Pass Fail Option 4 used then: 4 All accessible leaks repaired using smoke test. HERS rater must verify (No sampling). P f II accessible leaks h Pass i a accessia ea have been repaired using smoke Pass Fail Reg: 212-A0054244A-M2100001A-M21A Registration Date/Time: 2012/10/09'01:36:05 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms ' ~ March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-21 Duct Leakage Test — Existing Duct System (Page 2 of 2) Site Address: 53220 Avenida Mendoza, La Quinta CA 92253 (System Enforcement Agency: Permit Number: 1) City of La Quinta 12-1146 IN Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off during duct leakage testing. CFI OA ducts that utilize controlled motorized dampers, that open only when OA_ ventilation is required to meet ASHRAE Standard 62.2, and close when OA ventilation is not required, may be configured to the closed position during duct leakage testing.10 A t ® All supply/and return register,biiots must be sealed to the drywall if, smoke testis utilized for, compliance — applies"to duct leakage co/mpl�nce option 3 (leakage reduction•by 60%) and option'41(fix all'accessible q �4 leaks) described abov�er." lums)or ® New ductinstallations cannot utizebuilding cavities asf lelatform returns in lieu of ducts. ®Mastic and draw bands must tie 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 -6R), signed and submitted by the person(s) responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -1R) approved by the' ' enforcement agency. Builder or Installer information as shown on the Installation Certificate (CF -6R) i Reg: 212-A0054244A-M2100001A'-M21A ,Registration Date/Time:`i 2012/10/09•,01:36:05 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms r - - March 2010 Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) AIR EXPERTS AIR CONDITIONING -HEATING - Responsible Person's Name: CSLB License: Lisa Van Vlymen 725283try - HERS Provider Data RegisInformation Sample Group # (if applicable): N/A ® tested/verified dwelling ❑ not-tested/verified dwelling in a HERS sample group HERS Rater Information Ca10ERTS Certificate # CCl-1798695593 HERS Rater Company Name: Air Solutions of the Desert Responsible Rater's Name- Responsible Rater's Signature: Walter W Nellis Walter W Nellis Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 10/2/2012 ry CC2004361 y i Reg: 212-A0054244A-M2100001A'-M21A ,Registration Date/Time:`i 2012/10/09•,01:36:05 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms r - - March 2010