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MECH (11-0961)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: - 11-00000961 Property Address: 153605 AVENIDA MENDOZA APN: 774-132-016-5 -000000- Application description: MECHANICAL Property Zoning: COVE RESIDENTIAL Application valuation: 8985 Applicant: Architect or Engineer: BUILDING & SAFETY DEPARTMENT BUILDING PERMIT -------------------------------------------------- LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am icensed under provisions of Chapter 9 Icommencing with Section 70001 of Division 3 of the Business and ofessionals Code, and my License is in full force and effect. License Class: C20 License No.: 686310 /Date: q C Tactor: WNER-BUILDER DECLARATION 1 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 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 1 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: LQPERM IT Owner: RECKERS BETTY G 53605 AVENIDA MENDOZA UNKNOWN, CA 99999-9225 (003)000-0000 i VOICE (760) 777-7012 . FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 9/06/11 Contractor: p� �\�o GENERAL AIR CONDITION 31170 RESERVE DRIVE THOUSAND PALMS, CA 92276 (760)343-7488 q �� Lic. No.: 686310 --------------------------- - - - - -�------- 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 EVEREST NATL Policy Number 7600006147101 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 subj to the workers' compensation laws of California, and agree that, if I should become subject a workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwithply with those provisions. >p.,nnt: . WARNING:: FAILURE TO SECURE WORKERS' C ATION COVERAGE IS UNLAWFUL,'ANO SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS 1$100,0001 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 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 info a on is correct. I agree to comply with all city and county ordinances and state laws relating to building constr io , and hereby authorize representatives oft ' county to enter upon the above-mentioned property for inspe o purposes. Date: Signre (Applicant or Agent): LQPERMIT Application Number . . . . . 11-00000961 Permit . .. . MECHANICAL Additional desc . Permit Fee . . . . 40.50 Plan Check Fee 10.13 Issue Date . . . . Valuation . . . . 0 Expiration Date 3/04/12 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 4 TON HVAC SYSTEM, HEAT PUMP, AIR HANDLER -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 HVACAlterations CF -IR -ALT -HVAC - Climate Zones 10 to 15 Site Address: Enf cement ency: 3�dS Date: PerH: mit 8 � G Equipment T el Lis�MiniMrn Efficienc Z Duct insulation requirement Conditioned Floor Area Thermostat Cl Packaged Unit ttrnace ❑ AFUE v Over 40 ft of ducts added or _ ❑ COP KSetback ndoor Coil ❑SEER 13 ❑ HSPF replaced in unconditioned space Served by system (/J'noralready ndensing Unit EER !) ❑Resistance ❑ R 6 (CZ 10-13) sf present, nursr be ❑ Other ❑ R 8 (CZ 14-15) installed) 1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -1 R -ALT -HVAC jor each system. 2. Minimum Equipment Efficiencies: 13 SEER, 78%AFUE, 7.7HSPFfor 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 inspectof verifies that the work listed on this form was in fact the work completed by the installer. The inspector also verifies that each appropriate CF -6R and registered CF -4R forms (no hand filled CF-4Rs allowed) are filled out and si ed. Beginning October 1, 201.0, a registered copy of the CF -IR and CF -611 shall also be on site for final inspection. 1. HVAC Changeout Required Forms: • All HVAC Equipment replaced CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH- 25 -HERS CF -4R toH- rms: MEC• 21 and fors lits stems MECH-25 ` • Condenser Coil and /or • 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 Fnr Cnlit Cve+nr..e• r1-+ + Iv L .e i e - - - - -o- -- r- --•.., - LUrri,Ytuu,uu,rl rilr rtow mequirement), 1 MAH For Packaged Units: Duct leakage < 15 percent Exemptd "'in 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 ducts stems are constructed, insulated or sealed with asbestos ❑ 2. New HVAC System Required Forms: • Cut in or Changeout with new CF -6R forms: MECH-04, MECH-20-HERS,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)MECH-22, and MECH 25 new equipment) 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 furnace. Not all equipment changed. For Split Systems: Duct leakage < 6 percent, RC, CCA >_ 300 CFM/ton, TMAH For Packaged Units: Duct leakage <.6 percent ❑ 4. New Ducting over 40 feet Required Forms: • Includes adding or replacing more than 40 CF -6R forms: MEC14-04, MECH-2I-HERS CF -4R forms: MECH-21 linear feet of duct in unconditioned space. For split system or packaged units: Duct leakage < 15 percent ❑ EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos Contractor (Documentation Author's /Responsible Designer's Declaration Statement) • 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. • 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. • The design features identified on this Certificate of Compliance are consistent with the ' orm tion documented on other pplic ompliance forms, worksheets, calculations, plans andspecifications submitted to the enforcement agency fora ro at with t e emit application. Name: r!(�eh U/a.�`-Smv� Si ture: y , Company: Date: Ge-n,era,( t41' r Condi •`ort,' Address: 3170 Pesertle t License: tit. ✓� �8�3iv City/State/Zip: Phone:7—DL 74 eg Ca10ERTS`- CF -1R Registration Page 1 of 1 Public Hone Danielle Garcia logged in [Logout] . [Home] Secure Home CONGRATULATIONS About Us Your CF -1 R -ALT -HVAC Registration is complete! You may want to print this page for your records. 'Draining Site Address: 53605 AVENIDA MENDOZA Rater Directory La Quinta, CA 92253 CEC Registration: 211-A0045924A-00000000-0000 Forms CF -IR -ALT -HVAC: CLICK HERE TO DOWNLOAD Assigned Company: Energy Driven Solutions, Inc. Membership Benefits [CLICK HERE_ ] to do another Events Industry Partners - News " To register for our monthly newsletter, please click here. Copyright l,<;`•• ^010 C•:dCERTS, Ine. All rishts reserved. Revised:.lanuary 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 BBB SFmd us on`F8cb00 1eR hA T V ©' i I ' https://www.calcerts.com/public_cflR.cfm?project_id=136010 9/3/2011 Bin # City of La Quinta - Building 8i Safety .Mislon P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Buildin Perm -it it -Application ation and: Tracking Sheet Permit # C ` tJ` Project Address: S ' Owner's Name: A. P. Number: Address: a p Legal Description: City, ST, Zip: Contractor: Telephone:? S 3 s ` w•� x Address: T City, ST, Zip: _./ V Project Description: 4 Tyn 4VA- .- �! 14 ela4 1p Telephone: ' State Lie. # : 3 City Lie. Arch., Engr., Designer: Address: :.City., ST, Zip: Telephone:' -a>: f State Lie. #: Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo Ft: #Stories: # Units: Name of Contact Person: � p (,(c 0";IC5 OyvSq. Telephone # of Contact Person: -7& 4 3 Y3 Estimated Value of Project: APPLICANT: DO. NOT WRITE. BELOW THIS LINE # Submittal Req'd' Recd TRACIMG PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cafes. Reviewed, ready for cort•ections Plan Check Deposit Truss Calc s. Called Contact Person Plan Check Balance • Titte 24 Cales. Plans picked no Construction Flood plain plan Plans resubmitted Mechanical Grading plan tad Review, ready for correctionstissue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- 1rd Reyiew,.ready for correctionsrssue Developer Impact Fee Planning Approval Called Contact Person Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING • CF-411-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 5) Site Address: I Enforcement Agency: Permit Number: 53605 AVENIDA MENDOZA, La Quinta CA 92253 City of La Quinta 11-961 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 Handier, SystemName or Identification/Tag f7VO • ', "" %� eA VZ 17*071571 System Location or Area Served ❑ .Yes 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 ❑ 6? 5/16 inch l(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> .;and 2 is a pass. Enter Pass or Fail ✓ ❑ Pass ✓ ❑ Fail . • t STMS Sensor,onthe Evaporator-Coi1-. System :Nameror;Identification/Tag) f7VO • ', "" %� eA VZ 17*071571 3 ❑ .Yes �❑ No" The sensor is factory installed, orAfield,installed`according to manufacturers ' specifications, or is msEalled by d, fl approved bytthe Executive El Yes E] No , Director. 4 ,� ' p Yes?, § p:No` The sensor wire is terminated;..with a standard mini plug suitable for connectionxto a6 digital thermoriaeter The sensor mini"plug is:accessible to,the;installmg'technician The sensor wire is terminated with a standard mini plug suitable for connection to a and the' HERS 'rater.without'changing the airflow.thro.ugh the'conden5er coil' 5 ,r ❑ Yes ❑ No � When attached to a digital thermometer, the sensor provides an indication of the s ..,..- •, ., � saturation temperature of the coil. Yes to 3, 4, and 5 i a'pass. Enter N/A if STMS are not applicable. Otherwise enter Pass or, Fail' ✓ [:]N/A ✓ E] Pass ✓ ❑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 El Yes E] 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 ❑ Yes ❑ No When attached to a digital thermometer, the sensor provides an indication of the saturation temperature of the coil. Yes to 6, 7, and 8 is a pass. Enter N/A if STMS are not applicable. Otherwise enter Pass or Fail - W p N/A ✓ ❑Pass ✓ ❑Fail Reg: 211-A0045924A-M2500001A-M25A Registration Date/Time:'2011/09/11 22:06:55 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms +y 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: 53605 AVENIDA MENDOZA, La Quinta CA 92253 City of La Quinta 11-961 . 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 Conditioninq Svstems _ System Name or Identification/Tag (must be re -calibrated monthly) � Date of The Calibration "' L�3 x, ,.+ System Location or Area Served 1 " -' 4 =,w Outdoor Unit Serial # , Outdoor Unit Make Outdoor Unit Model Nominal Cooling Capacity Btu/hr Date of Verification ^ Calibration'of Diagnostic Instruments DateofRefrigerant Gauge Calibration (must be re -calibrated monthly) � Date of The Calibration "' L�3 x, ,.+ r ) fay ern " ; (must base -calibrated: monthly) Measured Temperatures' (IF) t , ' r "• I �` x � . - F F,;' System, m °rte fs 9 .3, Supply (evaporator #leaving) air dryYbulb; temperature (Tiupply,db) 1 " -' 4 =,w Return (evaporator -entering) air dry' -bulb temperature (Treturn, db) r' , Return (evaporator entering) air wet=bulb temperature (Treturn, wb) Evaporator saturation temperature- (Tevaporator, sat) ^ Condensor saturation temperature (Tcondensor, sat) Suction line temperature (Tsuction) Liquid Line Temperature (Tliquid) N Condenser (entering) air dry-bulb i temperature (Tcondenser, db)_ Reg: 211-A0045924A-M2500001A-M25A Registration Date/Time: 2011/09/11 22:06:55 HERS Provider: CalCERTS, Inc. 2.008 Residential Compliance Forms-, March 2010 INSTALLATION CERTIFICATE CF-4111-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5) Site Address: Enforcement Agency: Permit Number: 53605 AVENIDA MENDOZA, La Quinta CA 92253 City of La Quinta 11-961 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 = j Passes if difference is between -40F and +4°F or, upon remeasurement, if between -4°F and -100°F ` Enter Pass or Fail l. 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 -air -flow -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 _ 'Oox Calculated Minimum Airflowllk6 uirement (CFieM Measured Airflow usingRA3 3 pprocedures CFM Passes if measured airflow; is.,greaterthan,or, equal . to the calculated'mininiurim airflow`requirement:. Enter Pass or Fail - lk<. r .., 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 51 Reg: 211-A0045924A-M2500001A-M25A Registration Date/Time: 2011/09/11 22:06:55 HERS Provider: CalCERTS,' Inc. 2008 Residential ComplianceeForms March 2010 INSTALLATION CERTIFICATE CF-411-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure ' (Page 4 of 5) Site Address: Enforcement Agency: Permit Number: 53605 AVENIDA MENDOZA, La Quinta CA 92253 City of La Quinta 11-961 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 is • - -1 - , .. . Calculate: Actual Subcooling » , Tcondenser, sat - Tliquid Target Subcooling specified by manufacturer 4 ., Calculate difference: , Actual Subcooling - Target Subcooling = + ' passesif difference is between t C , E-4y-F d +4°F ` ^ --•-. Enter. Pass or Fail Metering Device Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag is • - -1 - , . Calculate: Actual Superheat,= , Tsuction - Tevaporator, sat' Enter allowable superheat range from 4 ., manufacturer's (or,userange , between 30E -and 26°F if manufacturer's specification is not available) + System 1passds4, actuaf,superheat is;"withinrthe allowablesu ran,e xs erheat P 9 r. a t C , p oi%dEntqrlor Fail ` ^ --•-. 9�C: �'' ...""* '�-`'k "�`' .i jr a. � L �4 `xa � tk W ...r`..,'.. i"�•'5-.n �� Yzi ix Y"Z�17 i + ` � � � .. R - _., �s ;ter ,ir 1. ; '+ ..y is • - -1 - , . ' 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: 53605 AVENIDA MENDOZA, La Quinta CA 92253 City of La Quinta 11-961 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 Danielle Garcia 686310 HERS Provider Data Registry Information Sample Group # (if applicable): 241918 System meets all refrigerant charge and airflow not-tested/verified dwelling in. a HERS sample group requirements. HERS Rater Company Name: Energy Driven Solutions, Inc. Responsible Rater's Name: Responsible Rater's Signature: Enter Pass or Fail David Bricker ' Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 8/22/2011 , CC2004131 p!✓'.x rrMt ��. DECLARATION STATEMENT]" • I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. . I am the certified HERS rater who Performed the verification services identified and reported on this certificate (responsible rater). • The installed feature, material, component, or manufactured device requiring HERS verification that is identified on this certificate (the installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified on the Certificate(s) of Compliance (CF -1R) approved by the local enforcement agency. • The information reported on applicable sections of the Installation Certificate(s) (CF -611), signed and submitted by the person(s) responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -111) 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 r Responsible Person's Name: CSLB License: Danielle Garcia 686310 HERS Provider Data Registry Information Sample Group # (if applicable): 241918 ❑ tested/verified dwelling not-tested/verified dwelling in. a HERS sample group HERS Rater Information CaICERTS Certificate # CCl-1798589803 HERS Rater Company Name: Energy Driven Solutions, Inc. Responsible Rater's Name: Responsible Rater's Signature: David Bricker David Bricker ' Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 8/22/2011 , CC2004131 T" Reg: 211-A0045924A-M2500001A-M25A Registration Date/Time: 2011/09/11 22:06:55•' HERS Provider: Ca10ERTS, Inc. 2008 Residential -Compliance Forms March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-21 ❑ 1. Measured leakage less than -15% of fan flow � ' Duct Leakage Test — Existing Duct System (Page 1 of 2) 3. Reduce leakage Site Address: 53605 AVENIDA MENDOZA, La Quinta CA 92253 (System Enforcement Agency: Permit Number: Note: (One of Optons.l, 2, or 3 must be:attempted,before,utilizing Option4.)„�. 1) City of La Quinta 11-961 ' %0'0 Measui`ed,system'airflow using RA3.3 airflowsfproc CFM Enter the Duct System Name or Identification/Tag: Enter the Duct 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. ❑ 1. Measured leakage less than -15% of fan flow � ' O 2. Measured leakage to outsidelessthan 10% of•Fan Flow J 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 Optons.l, 2, or 3 must be:attempted,before,utilizing Option4.)„�. Determine nominal Fan'Flow using one ofothe following.th'ree.caiculation methods ff A � s. 4 o _, ✓ ❑ Coojling system method: Size of condenser in Tons x 400 _' �' "CFM n � �. ✓ ❑ Heating system method: 21.7 x Output Capacity in=Thousands of Btu' /hr i�,Nf � sem' ) lure %0'0 Measui`ed,system'airflow using RA3.3 airflowsfproc CFM Optioin'1 used then r: ' $ 9 Allowed leakage — Fan Flow 4 yx 0 15 CFM 1 _ Actual Leakage'= _CFM , , Pass if Leakage Actual is less than Allowed • Pass Fail Option 2 used then:,,,,i `x0.10 2 Allowed leakage Fa'Flow ° = _ CFM Actual Leakage to outside.= t_-; CFM Pass if Leakage Actual is less than Allowed 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 3 Initial leakage_ - Final leakage _ = Leakage reduction - CFM ' ((Leakage reduction _ / Initial leakage _) x 100% _ % Reduction Pass if % Reduction > 60% Pass Fail Option 4 used then: 4 All accessible leaks repaired using smoke. HERS rater must verify (No sampling). No smoke allowed to leak., rom system. Including ducts, plenums, air handler and door panel. • Pass if all accessible leaks have been repaired using smoke Pass Fail Reg: 211-A0045924A-M2100001A-M21A Registration Date/Time: 2011/09/11 22:00:24 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: 53605 AVENIDA MENDOZA, La Quinta CA 92253 (System Enforcement Agency: Permit Number: 1) City of La Quinta•. - 11-961 , ❑ Outside air (OA) ducts for CentralFan Integrated (CFI) ventilation systems, shall not be sealed/taped off duri,ng'°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. ❑ All supplyrand return register'boots must belsealed to the drywall if, smoke uti test is lized ford ompliance - applies'to' duct leakage compliance option 3 (leakage reduction b'y60%)',and option 4 (fix all -accessible leaks) described above ❑ New duct installa-�rtions,.cannot utilize 6uildinb.cavities as plenums •riplatf6ret m rurns in lieu of duccr, 101 ts.. ❑ Mastic and d�aw`bands:must be used;in combination with'cloth°backed rubber.adhesive duct tape to seal `+ , leaks at all new duct connections ' DECLARATION STATEMENTI • I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. • I am the certified HERS rater who performed the verification services identified and reported on this certificate (responsible rater). • The installed feature, material, component, or manufactured device requiring HERS verification that is identified on this certificate (the installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified on the Certificate(s) of Compliance (CF -1R) approved by the local enforcement agency. • The information reported on applicable sections of the Installation Certificate(s) (CF -6R); signed and submitted by the person(s) responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -1R) approved by the enforcement agency. Builder or Installer. information as shown on the.Installation Certificate (CF -6111) - 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): 241918 ❑ tested/verified dwelling not-tested/verified dwelling in a HERS sample group HERS Rater Information CaICERTS Certificate # CC1-1798589803 HERS Rater Company Name: y Energy Driven Solutions, Inc. Responsible Rater's Name: Responsible Rater's Signature: David Bricker David Bricker Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 8/22/2011 CC2004131 - Reg: 211-A0045924A-M2100001A-M21A Registration Date/Time: 2011/09/11 22:00:24 HERS.Provider: Ca10ERTS, Inc. . 2008'Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS Duct Leakage Test - Existing Duct System (Page 1 of 2) Site Address: 53605 AVENIDA MENDOZA, La Quinta CA 92253 (System Enforcement Agency: Permit Number: 1) City of La Quinta 11-961 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 dud system Select one compliance method from the following four choices. p 1. Measured leakage less than 15% of fan flow ❑ 2. Measured leakage to outside less than'l0% of Fari Flow ❑ 3. Reduce leakage byf60% 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 Far`,Flow using one`of.the following three calculation methods ✓ JP 0 Coolin s stem method: Size of condenser in Tons – M t 9 Y 4 x 400. - 1600 CFM y ✓ ❑ Heating system method: 21.7-)C Output Capacity in Thousands of.Btu/hr = CFM _ ✓❑ fi Measured system airflow using•RA3.3 ahflowbtest procedures: CFM e-:.� Optional used. then rte . zra.,. Allowed leakage – Fan'Airflow 1600' x 0.15 240 - CFM 1'. Actual Leakage— 230 CFM j ;':. Pass if Actual Leakage is less than Allowed leakage Pass Fail Option 2 used then:\ 2 Allowed leakage = Fan"Airflo '• x 0.10 = _CFM Actual Leakage to outside= f - CFM - `-q Pass if Actual leakage to outside is less than Allowed leakage R 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 3 Initial leakage _ - Final leakage _ = Leakage reduction _ CFM' ((Leakage reduction _/ Initial leakage �, x•100% _ % Reduction ' Pass if % Reduction > 60% Pass Fail Option 4 used then: 4 All accessible leaks repaired using smoke test. HERS rater must verify (No Sampling). Pass if all accessible leaks have been repaired using smoke Pass Fail Reg:•211-A0045924A-M2100001A-0000 Registration Date/Time: 2011/09/11.21:06:40 HERS Provider: CalCERTS, Inc. 2008 Residential.Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS HARRISON ENTERPRISES INC Duct Leakage Test - Existing Duct System (Page 2 of 2) Responsible Person's Signature:. Site Address: 53605 AVENIDAMENDOZA, La Quinta CA 92253 (System Enforcement Agency: Permit Number: Date Signed: 8/17/2011 1) City of La Quinta 11-961 Control Program (TPQCP)? ❑ Yes ❑ No 0 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. , D All s6pply,andi6turn register boom ts ust be�sea ped to the dry�wall'If smoke oke testis utili ed for�compliance' . - applies to`duct leakage compliance option 3 (leakage reduction by:60 /o);and option 4 (,fix all accessible leaks) described above. 9 I ,,; 0 New duct'lnstalla�trlons=cannot utilize building cavities asfplenums)or�platform returns m lieu of ducts / D Mastic andedraw bands must 'be used i.i com6lnatlon with elotFi:backed rubber:adhesive,du:ct'tape to seal leaks at all new duct connections",- DECLARATION onnections, 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 -111) form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF -1R that apply to the installation have been met. • I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. I will ensure that all Installation Certificates will come from a HERS provider data - registry for multiple orientation alternatives, and beoinnina October 1. 2010. for all low-rise residential huiidinnc' Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) , HARRISON ENTERPRISES INC Responsible Person's Name: Responsible Person's Signature:. Danielle Garcia Danielle Garcia CSLB License: 686310 Date Signed: 8/17/2011 Position With Company (Title): Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? ❑ Yes ❑ No • . Reg: 211-A0045924A-M2100001A-0000 Registration Date/Time: 2011/09/11 21:06:40 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 0 INSTALLATION CERTIFICATE* I CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page i of 5) Site Address: Enforcement Agency: Permit Number: 53605 AVENIDA MEND OZA, La Quinta CA 92253 City of La Quinta 11-961 Note: If installation of a Charge Indicator Display (CID) is utilized as an alternative to refrigerant charge verification for compliance, a MECH-24 Certificate (instead of this MECH-25 Certificate) should be used to demonstrate compliance with the refrigerant charge verification requirement. TMAH and STMS are not required for compliance, when a CID is utilized for compliance. As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional form(s) for any additional systems in the dwelling as applicable. Temperature Measurement Access Holes (TMAH) and Saturation Temperature Measurement Sensors (STMS) ; Procedures for installing TMAH are specified in Reference Residential Appendix RA3.2. If refrigerant charge verification is required for compliance, TMAH are also required for compliance. STMS are only required for completely new or _ replacement space -conditioning systems that utilize prescriptive compliance method. , TMAH - Access Holes in Supply and Return Plenums of Air Handler System Name or Identification/Tag System 1 System Location or Area Served Whole House 1 p Yes ❑ No 5/16 inch (8 mm) access hole upstream of evaporative coil in the return plenum and labeled according to Figure in Section RA3.2.2.2.2. 2 p Yes• El -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,i,and 2 is a pass. ` Enter Pass or Fail ✓ 2 Pass ✓ ❑ Fail STMS`- Sensor on -the Evaoorator-_Coil . System'Name.or Identification/Tag� �' S stem ice- e:. - � . ,4 ��:,,,�`„�°` "`�-' ,y""" , , .,� �, 'Kn � "�' 7 (71 3 ❑:Yes ®"Nom �. The sensor is factory installed; or field'installed according to manufacturer s specifcetions, or islinstalled by methods/specifications approved by"the Executive ❑ Yes ❑ No 1 Director. 'Director.�,-- 4 d Yes r ) 3 No The sensor wide is terminated_with a standardrmini plug suitable forconne, Ion::rto a r digital thermometer: The sensor mini plug isaccessible to the installing, technician ❑ Yes �' ",`a `'- : ,•a and the HERS, rater,without,changing.the airflowthrough the condenser coil" 5 ❑Yes❑ No 7 i The sensor measures the saturation temperature of the coil within 1.3 degrees F Yes to.3;.4 and 5 is a''Ipass. Enter N/A if STMS are not applicable.`: Otherwise enter Pass ori Fail ✓ p N/A , ✓ • ❑ Pass ✓ ❑ Fail STMS - Sensor on the Condenser Coil System Name or Identification/Tag - System 1 The sensor is factory installed, or field installed according to manufacturer's 6 ❑ Yes ❑ No specifications, or is installed by methods/specifications approved by the Executive Director. The sensor wire is terminated with a standard mini plug suitable for connection to a 7 ❑ Yes ❑ No digital thermometer. The sensor mini plug is accessible to the installing technician and the HERS rater without changing the airflow through the condenser coil 8 ❑ Yes ❑ No 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 ✓ © N/A ✓ ❑Pass ✓ El Fail applicable. Otherwise enter Pass or Fail 0 2008 Residential Compliance Forms - August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5) Site Address: Enforcement Agency: Permit Number: 53605 AVENIDA MENDOZA, La Quinta CA 92253 1 City of La Quinta 11-961 Standard Charge Measurement Procedure (for use if outdoor air dry-bulb is above 55°F) Procedures for determining Refrigerant Charge using the Standard Charge Measurement Procedure are available in Reference Residential Appendix RA3.2. As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional form(s) for any additional systems in the dwelling as applicable. • The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure. • The system must meet minimum airflow requirements as prerequisite for a valid refrigerant charge test. - • If outdoor air dry-bulb is 55°F or below, the installer must use the Alternate Charge Measurement Procedure. Space Conditioning Systems System Name or Identification/Tag System 1 ' 4 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5) Site Address: Enforcement Agency: Permit Number: 53605 AVENIDA MENDOZA, La Quinta CA 92253 1 City of La Quinta 11-961 Standard Charge Measurement Procedure (for use if outdoor air dry-bulb is above 55°F) Procedures for determining Refrigerant Charge using the Standard Charge Measurement Procedure are available in Reference Residential Appendix RA3.2. As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional form(s) for any additional systems in the dwelling as applicable. • The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure. • The system must meet minimum airflow requirements as prerequisite for a valid refrigerant charge test. - • If outdoor air dry-bulb is 55°F or below, the installer must use the Alternate Charge Measurement Procedure. Space Conditioning Systems System Name or Identification/Tag System 1 (must be re -calibrated monthly) � System Location or Area Served Whole House 8 15=11� (must be re -calibrated monthly) tiP `t Outdoor Unit Serial # 1002483421 Outdoor Unit Make Lennox Outdoor Unit Model ASZC160481 Nominal Cooling Capacity Btu/hr 47500 Date of Verification 8-17-11 Calibration of Diagnostic Instruments Date of Refrigerant Gauge Calibration 8 -15 -ii (must be re -calibrated monthly) � Date of Th,yermocouple Calibration?�} 8 15=11� (must be re -calibrated monthly) tiP `t Supply (evaporator leaving)�air dry-bulb4 '" _ •,+ 63 rieasureu o emoeratures,.a -r i -� f .;f..i = INSTALLATION CERTIFICATE I CF-611-MECH-25-HERS Refrigerant Charge Verification -Standard Measurement Procedure (Page 3 of 5) Site Address: Enforcement Agency: Permit Number: 53605 AVENIDA MENDOZA, La Quinta CA 92253, City of La Quinta 11-961 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. e � V INSTALLATION CERTIFICATE I CF-611-MECH-25-HERS Refrigerant Charge Verification -Standard Measurement Procedure (Page 3 of 5) Site Address: Enforcement Agency: Permit Number: 53605 AVENIDA MENDOZA, La Quinta CA 92253, City of La Quinta 11-961 Minimum Airflow Requirement Temperature Split Method Calculations for determining Minimum Airflow Requirement for Refrigerant Charge Verification. The temperature split method is specified in Reference Residential Appendix RA3.2. System Name or Identification/Tag System 1 ' Calculate: Actual Superheat = Calculate: Actual Temperature Split = Treturn, - 22.00 db - Tsupply,db Target Temperature Split from Table RA3.2-3 - 21.3 i using Treturn, wb and Treturn, db Calculate difference: Actual Temperature Split'- 0.7 ' Target Temperature Split = - Passes if difference is between -3°F and +3°F or, f upon remeasurement, if between -3°F and PASS -100°F Enter Pass or Fail ' Note:._ Temperature Split Method Calculation'is not necessary if actual. Cooling;Co l Airflow, is verified using one of the airflow measurement procedures specified in Reference Residential Appendix RA3.3. If actual cooling coil airflow is measured, the value must be equal to or greater than the Calculated Minimum Airflow Requirement in the table below. Calculated Minimum Airflow Requirement (CFM) = Nominal Cooling Capacity (ton) X 300 (dm/ton) Systemy'Name or Identification/Tag`�", System 1 Calculated Minimum Airflow Requirement (CFM) Measured Airflow,using RA3.3 procedures (UM.).121 h - I e • -, .,, 49, Passes if measured airflow is greater than equal to the calculated minimum airflow requirement:""-- - ' " Enter Pass or Fail Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for fixed orifice metering device'systems System Name or Identification/Tag System 1 Calculate: Actual Superheat = Tsuction - Tevaporator, sat Target Superheat from Table RA3.2-2 using Treturn, wb and Tcondenser, db Calculate difference: Actual Superheat - Target Superheat = System passes if difference is between -5°F and +5°F f Enter Pass or Fail { .y Reg: 211-A0045924A-M2500001A-0000 Registration Date/Time: 2011/09/11 21:08:23 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms August 2009 Reg: 211-A0045924A-M2500001A-0000 Registration Date/Time: 2011/09/11 21:08:23 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5) Site Address: Enforcement Agency: Permit Number: - 53605 AVENIDA MENDOZA, La Quinta CA 92253 City 'of La Quint: 11-961 Subcooling Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag System 1 Calculate: Actual Subcooling = 6.0 Tcondenser, sat - Tliquid k Target Subcooling specified,by manufacturer 8 Calculate difference: _2 " Actual Subcooling - Target Subcooling = System passes if difference is between -3°F and +3°F PASS ' Et n er Pass or Fail, {y' Metering Device Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. - System Name or Identification/Tag System 1 Calculate: Actual Superheat = : t 13.0 Tsuction - Tevaporator, sat 'V i , . . k Enter allowable superheat range from •: manufacturer's'specifications (or use range. 2S between 4°F and 25°F if manufacturer's specification is not available) System passes if;actual',superheat is-withig4the allowable.su erheat range P 9`. PASS , M F. �, EnteIN r Pass oc Fail {y' RIP,L t ^ 1 ' l ' Reg: 211-A0045924A-M2500001A-0000 Re4istration Date/Time: 2011/09/11 21:08:23 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms • August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5) Site Address: Enforcement Agency: Permit Number: 53605 AVENIDA MENDOZA, La Quinta CA 92253 City of La Quinta 11-961 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 a System 1 CSLB License: 686310 Date Signed: 8/17/2011 position With Company (Title): Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable):, Control Program (TPQCP)? ❑Yes [_No System meets all refrigerant charge and airflow requirements. PASS Enter Pass or Fail t r �''F^�W`- ;,• �'�`"Y �r�.:-`�a- �! � _ . DECLARATIONSTATEMENT ~ • 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) i conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the enforcement agency. • I understand that a HERS rater will check the installation to verify compliance, and that that if such checking identifies defects, I am required to take corrective action at my expense. I understand that Energy Commission and HERS provider representatives will also perform quality assurance checking of installations, including those approved as part of a sample group but not checked by a HERS rater, and if those installations fail to meet the requirements of such quality assurance checking, the required corrective action and additional checking/testing of other installations in that HERS sample group will be performed at my expense. • I reviewed a copy of the Certificate of Compliance (CF -111) form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF -1R that apply to the installation have been met. , • I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. I will ensure that all Installation Certificates will come from a HERS provider data registry for multiDle orientation alternatives. and hen inni no Octo her 1. 2 n 1 n- fnr all Inw-rico rec irlenrial hnilrii nnc Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) HARRISON ENTERPRISES INC Responsible Person's Name: Responsible Person's Signature: Danielle Garcia Danielle Garcia. CSLB License: 686310 Date Signed: 8/17/2011 position With Company (Title): Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable):, Control Program (TPQCP)? ❑Yes [_No Reg: 211-A0045924A-M2500001A-0000 Registration Date/Time: 2011/09/11 21:08:23 HERS Provider: Ca10ERTS,.Inc. 2008 Residential Compliance Forms August.2009 • .r�