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MECH (12-0484)r'P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 12-00000484 Property Address: 56850 MERION APN: 762 -032 -011 - Application description: MECHANICAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 17830 c&ht 4 4 Q" Applicant: Architect or Engineer: C,orrcAAre�A� � --------------- - - - - - - LICENSED C NTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am lice d under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and ProVio Code, and my License is in full force and effect. License Class: C20 cense No.: 686310 Date: Contractor: ER -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.). (_) 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 Owner: BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Date: 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 Owner: MOFFIT, JOHN M 1324 N LIBERTY LAKE RD LIBERTY LAKE, WA 99019 Contractor: GENERAL AIR 31170 RESERV THOUSAND PAL (760)343-748 Lic. No.: 68 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 5/03/12 ------------------ WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations:. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. _ I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier ZENITH INS CO Policy Number Z071741501 _ I certify that, in the performance of the work for h this permit is issued, I shall not employ any person in any manner so as to become subjec the workers' compensation laws of California, and agree that, if I should become subject to workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith co ly with those provisions. CDate: 5 3 Applicant: WARNING: FAILURE TO SECURE WORKERS' OMPE TION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AN CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. 1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application, the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the a information is correct. I agree to comply with all city and county ordinances and state laws relating to buildi onstruction, and hereby authorize representatives of this county to enter upon the above-mentioned property inspe ion purposes. Date: 51311 Signature (Applicant or Agent): Application Number . . . . 12-00000484 Permit . . . MECHANICAL Additional desc . Permit Fee . . . . 51..00 Plan Check Fee 12.75 Issue Date . . . . Valuation 0 Expiration Date . . 10/30/12 Qty Unit Charge Per Extension BASE FEE 15.00 2.00 9.0000 EA MECH FURNACE <=100K 18.00 2.00 9.0000 EA MECH B/C <=3HP/100K BTU = 18.00 ------------=-------------------------------------------------------------- Special Notes and Comments HVAC CHANGE OUT - (2) 13SEER/78AFUE SPLIT SYSTEMS [2008 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2010 CALIFORNIA BUILDING CODES. May 3, 2012 12:48:41 PM AORTEGA --------------------------7------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged Paid Credited ---------------------------------------- Due ----------------- Permit.Fee Total 51.00 .00 .00 51.00 Plan Check Total 12.75 .00 .00 12.75 Other Fee Total 1.00 .00 .00 1.00 Grand Total 64.75 .00 .00 64.75 LQPERMIT Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-lR-ALT-HVAC Climate Zones 10 - 15 Site Address: Enforcement Agency: Date: Permit #: 56850 MERION La Quinta, CA 92253 City of La Quinta May 2, 2012 Duct insulation Conditioned Floor Equipment Type1 List Minimum Efficiency2 requirement Area Thermostat ❑ Package Unit ® Furnace ® Indoor Coil ® AFUE 8% ® SEER 13.0 ❑ COP [3HSPF ❑ R 6 (CZ 10-13) Served by system ® Setback If not already present, must be ® Condensing Unit ❑ EER ❑ Resistance ❑ R 8 (CZ 14-15) 2353 sf 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-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-1111 and CF-6111 shall also be on site for final inspection. ® 1. HVAC Changeout Required Forms: • All HVAC Equipment CF-6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS replaced CF-4R forms: MECH-21 and (for split systems) MECH-25 • Condenser Coil and /or • Indoor Coil and /or CF-6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS . Furnace CF-4R forms: MECH-21 and (for split systems) MECH-25 For Split Systems: Duct leakage�< 15 percent; RC, CCA <_ 300 CFM/ton (Minimum Air Flow Requirement), TMAH 15 perreRl; 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 (:13. Existing duct systems are constructed, insulated or sealed with asbestos ❑ 4. The�systemawill not be Ducted (ie.,Ductless:Mini-S pi it-System)-(Also-Exempt-from,.Refrigerant-Charge) ❑ 2. New' HVAC System Required Forms: • Cut inlor Changeout with" new ducts: / * CF 611 forms: MECH-04, MECH-20;HERS, and (for split systems) MECH-22-HERS, and- (all new ducting An all new MECH-25;HERS CF 4R forms: MECH-20 and (for split systems) MECW22, and—'ME CH-25 equipment) R fj - For Split Systems: Duct leakage < 6`percent; RC, CCA >: 350 CFM/ton, FWD, TMAH, STMS, and either HSPP or PSPP. `� = '< For Packaged Units: Duct leakage6 percent ❑ 3. New-Ducts with/or without Required Forms: Replacement V1, j . 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-4R 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-6R forms: MECH-04, MECH-2I-HERS linear feet of duct in unconditioned space. CF-4R forms: MECH-21 For split system or packaged units: Dud 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. • 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 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: Danielle Garcia Signature: banielle Garcia Company: HARRISON ENTERPRISES INC Date: May 2, 2012 Address: 31-170 RESERVE DRIVE STE A License: 686310 City/State/Zip: THOUSAND PALMS / CA / 92276 Phone: (760) 343-7488 Reg: 212-A0022073A-00000000-0000 Registration Date/Time: 2012/05/02 21:02:32 ITERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms July 2010 Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -IR -ALT -HVAC Climate Zones 10 - 15 Site Address: Enforcement Agency: Date: Permit #: 56850 MERION (SYS 2) La Quinta, CA 92253 City of La Quinta May 2, 2012 Equipment Type1 List Minimum Efficiency 2 Duct insulation requirement Conditioned Floor Area Thermostat ❑ Package Unit ® Furnace ® Indoor Coil ® AFUE 78% ® SEER 13.0 ❑ COP [3HSPF ❑ R 6 (CZ 10-13) Served by system ® Setback If not already present, must be ® Condensing Unit ❑ EER ❑ Resistance ❑ R 8 (CZ 14-15) 2353 sf installed) ❑ Other 1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -1R -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 -6R and registered CF -411 forms (no hand filled CF-4Rs allowed) are filled out and sig ned.Beginning October 1, 2010, a registered copy of the CF -1111 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 and (for split systems) MECH-25-HERS replaced CF -4R forms: MECH-21 and (for split systems) MECH-25 . Condenser Coil and /or . Indoor Coil and /or CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS . Furnace CF -411 forms: MECH-21 and (for split systems) MECH-25 For Split Systems: Duct leakage,< 15 percent; RC, CCA <_ 300 CFM/ton (Minimum Air Flow Requirement), TMAH 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 Refrigerapt°Charge) ❑ 2. New HVAC System Required Forms: ) '• q . Cut in'or Changeout with new ducts: (all new ,/ CF 611 forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-22-HERS, and ductirlg �, all new " MECH-25-HERS y „��a' --•;..-�;,,.� CF -4R forms: MECH-20, and (for split systems) MECH-22, and MECH-25 y �c 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 113 . New Ducts with/or without Required Forms: Replacement I.,J . Includes replacing or installing all new ducting and/or outdoor condensing unit CF -611 forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS and/or indoor coil and/or furnace. No or some CF -4R 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 -6R forms: MECH-04, MECH-2I-HERS linear feet of duct in unconditioned space. CF -4R forms: MECH-21 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. • 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 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: Danielle Garcia Signature: Danielle Garcia Company: HARRISON ENTERPRISES INC Date: May 2, 2012 Address: 31-170 RESERVE DRIVE STE A License: 686310 City/State/Zip: THOUSAND PALMS / CA / 92276 Phone: (760) 343-7488 Reg: 212-A0022074A-00000000-0000 Registration Date/Time: 2012/05/02 21:03:37 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms July 2010 Bin # Cit/ O La Quinia Building & Safety Mslon Permit # P.O. Box 1504, 78-495 Calle Tampico La Qulnta, CA 92253 - (760): 777-7012 V1 .Building Permit Application and Tracking Sleet Project Address: M O i 1 on Owner's Name: J.0 �" t A. P. Number: � b 2 0 9 20 1_ U Address:Gic,;5o no on Legal Description: City, ST, Zip: LQ C4k Contractor:ALL Telephone: (� - 4•C-{ Q - 1203 "•` _ Address: RD R�tvjL Project Description; C r ' o cGi l ' o1 1T City, ST, Zip:'—sc�Nk C-2 J J QUI 1 �J S Telephone: '� i� ; '� ;{ :; r• state Lie. # : 3 City Lic. #: 410 (10 Arch., Engr., Designer: Address: City ST Zip: .... , . Telephoner xx'• Construction Type: Occupancy: State Lic. #: � � ` Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: 20 eel� YU Sq. FL: 2 CJ 3 # Stories: # Units: Telephone # of Contact Person: -7& O 3'1-6 % �' g Estimated Value of Project: �, g 30 , (Do APPLICANT- nr% hlr%r %mo re nm nu, -r"on , ui, Submittal Rc, RCMGq PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calls. Called Contact Person Plan Check Balance. Title 24 Cales. .Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan tad Review, ready for corrections/Issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up. S.M.I. H.O.A. Approval Plans resubmitted Grading IN 1r° Reyiew,.ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P.. Pub. Wks..Appr. Date of permit issue School. Fees Total Permit Fees mof%� INSTA.LILATION CERTIFICATE CF-6R-MECH-2I-HERS Duct Leakage Test - Existing Duct System (Page 1 of 2) Site Address: Enforcement Agency:Permit Number: 56850 MERION, La Quinta CA 92253 (System 1) City of La Quinta 12-0484 Enter the Duct System Name or Identification/Tag: System 1 Enter the Duct System Location or Area Served: Master Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the dwelling. This 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 Leakaqe Diagnostic Test - existina duct system Select one compliance method from the following four choices. ❑ 1. Measured leakage less than 15% of fan flow I] 2. Measured leakage to outside less than 10% of Fan Flow ® 3. Reduce leakage by 60% and conduct smoke and fix all leaks p 4. Fix -all accessible leaks using smoke and HERS rater verify 4 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 . ✓ 0 Coolg system method: Size of condettser in Taris �,� x 400 =_1._120_'\0FM - ✓ ❑ Heating system method., '21.74x =r Output Capacity in,Thbusand of Btu /hr, ` CFM+ (y rocedures: L yV ✓❑ Measured system,airflgw usimg RA3.3 airflow test. CFMr Option L,.used then: •r N. Allowed 1 leakage=;Fan'Airflow=x 0.15 = _CFM`—i Actual Leakage = _ CFM � %. ! Pass if Actual Leakage is less than Allowed leakage E3 Pass Fail Option 2 used then: 2 Allowed leakage = Fan Airflow_ x 0.10 = _ CFM Actual Leakage to outside = 1 CFM Pass if Actual leakage to outside is less than Allowed leakage El Pass E3 Fail Option 3 used then: Initial leakage prior to start of work= 898 CFM Final leakage after sealing all accessible leaks using smoke test= 359 CFM 3 Initial leakage 898 - Final leakage 359 =Leakage reduction 539 CFM ((Leakage reduction 539 / Initial leakage 898 1 x 100% = 60.02 0/aReduction Pass if % Reduction > 600/6 io 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 r3 Pass ❑ Fail Q 1� Reg: 212-A0022073A-M2300001A-0000 Registration Date/Time: 2012/06/11 20:18:29- HERS Provider: Ca10ERTS, 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:Enforcement Agency: Permit Number: 56850 MERION, La Quinta CA 92253 (System 1) City of La Quinta 12-0484 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. l 0 All supply�and,return register boots must be,sealed,tolthe drywall If, smoke,testgis,utilized for, compliance - applies to duct leakage compllance option 38 (lean age`reduction try 60%)"sand}option 4,(fix all accessible leaks) described above. Y., j 1' 0 New duct installations cannot utilize building cavities asfplenums or platform returns in lieu of"du&s., 0 Mastic,and.drawlbands must be used; in-combinatlonTwith cloth backed, rub be r, adhesiveduct tape�to seal Ls leaks at all new duct connections N 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). • 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. • 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 fall to meet the requirements of such quality assurance checking, the required corrective action and additional checking/testing of other Installations In that HERS sample group will be performed at my expense. • I reviewed a copy of the Certificate of Compliance (CF -111) form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF -111 that apply to the installation have been met. • I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. I will ensure that all Installation Certificates will come from a HERS provider data registry for multiple orientation alternatives, and beginning October 1, 2010, for all low-rise residential buildinas. 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: 5/7/2012 Position With Company (Title): Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? ❑ Yes ❑ No Reg: 212-A0022073A-M2100001A-0000 Registration Date/Time: 2012/06/11 20:18:29 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE* CF-6R-MECH-25-HER: Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 R7, Site Address: Enforcement Agency: Permit Number: 56850 MERION, La Qulnta CA 92253 City of La Quinta 12-0484 Note: If installation of a Charge Indicator Display (CID) is utilized as an alternative to refrigerant charge verification for compliance, a NECH-24 Certificate (instead of this MECH-25 Certificate) should be used to demonstrate compliance with the refrigerant charge verification requirement. TMAH and STNS 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 SuD01V and Return Pienumc of sir Mandlnr System Name or Identification/Tag System i System Location or Area Served Master 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. land 2 0 Yes ❑ No 5/16 inch (8 mm) access hole downstream of evaporative coil in the supply plenum labeled according to Figure in Section RA3.2.2.2.2. Yes to 1 and 2 is a pass. i Enter Pass or Faill ✓ ® Pass ✓ ❑ Fail STMS - Sensor on the Evaporator Coil System Name or Identification/Tag*) f� r,r System 1-� I I - _. - N , r - I - i t. ' 3 /13 Yes El 4P , j� r1` % The sensor is factory installed, or�field installed according to manufacturer's specifications, or i� installed by m ethcds/specific ions approved by,the Executive Director. -'s _;- 4 ❑ Yes rf ❑ No The sensor wire is terminated with a standard mini plug suitable for connection to a 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 [3 Yes ❑ No The sensor measures the saturation temperature of the coil within 1.3 degrees F Yes to 3, 4, -and 5 is a pass. Enter N/A if STMS are not applicable. Otherwise enter Pass or, Fail ✓ 0 N/A ✓ ❑Pass ✓ ❑Fail STMS - Sensor on the Condenser Coil System Name or Identification/Tag I System i 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 I ❑ 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 applicable. Otherwise enter Pass or Fail ✓ la N/A ✓ ❑ Pass ✓ ❑ Fail Reg: 212-A0022073A-M2500001A-0000 Registration Date/Time: 2012/06/11 20:20:05 HERS Provider: Ca10ERTS, Inc. 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: 56850 MERION, La Quinta CA 92253 City of La Quinta 12-0484 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 Change Measurement Procedure. Space Conditioning Systems System Name or Identification/Tag System 1 (must be re -calibrated monthly) Date of Thermocouple Calibration j ��% , . 5-1-12 System Location or Area Served Master �. Outdoor Unit Serial # 1912A29423 Outdoor Unit Make Lennox Outdoor Unit Model 14ACX-036-230 Nominal Cooling Capacity Btu/hr 34400 Date of Verification 5-7-12 a-anDravon or Nla9nostic instruments Date of Refrigerant Gauge Calibration 5-1-12 (must be re -calibrated monthly) Date of Thermocouple Calibration j ��% , . 5-1-12 _`must be ri calibrated monthly) �i ! �. rreasurea semperatures t r) )! .r F f • n 1 1 IL. n System Name or IdentificationfTagSystem 1 X h i � irr rr `r, l �i ! Supply (evaporator leaving) air dry-bulb' - temperature (Tsupply, db) ' ) 52 _ " Return (evaporator entering) air dry-bulb 79 temperature (Tretum, db) r Return (evaporator entering) air wet -bulb 59 temperature (Treturn, wb) Evaporator saturation temperature 43 (Tevaporator, sat) Condensor saturation temperature 101 (Tcondensor, sat) Suction line temperature (Tsuction) 62 Liquid Line Temperature (Tliquid) 93 Condenser (entering) air dry-bulb 90 temperature (Tcondenser, db) t Reg: 212-A0022073A-M2500001A-0000 Registration Date/Time: 2012/06/11 20:20:05 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS Duct Leakage Test — Existing Duct System (Page 1 of 2) Site Address: 56850 MERION (SYS 2), La Quinta CA 92253 (System Enforcement Agency: Permit Number: 1) City of La Quinta 12-0484 Enter the Duct System Name or Identification/Tag: System 2 Enter the Duct System Location or Area Served: Living 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. 0 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 4,)_ Determine nominal Fah Flow using one ofthe following three calculation methods./,,-' ✓ ® Cooling system method: Size of condenser in Tons !,g_ x 400 = i 120o CFM ✓ ❑ Thousands Heating system method 21.7 x _ Output Capaciy in of Btu/hr = CFM ✓ ❑ Measured system airflow using RA3.3 airflow test procedures:' CFM Option 1 used then: 1 Allowed leakage = Fan Airflow 1200 x 0.15 = 180 CFM Actual Leakage = 100 CFM Pass if Actual Leakage is less than Allowed leakage Fa Pass Fail Option 2 used then: 2 Allowed leakage = Fan Airflow_x 0.10 = _ CFM Actual Leakage to outside = FM Pass if Actual leakage to outside is less than Allowed leakage a Pass Q 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% _ /b Reduction Pass if % Reduction > 600/6 Pass a 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: 212-A0022074A-M2100001A-0000 Registration Date/Time: 2012/06/11 20:21:57 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-6R-MECH=21-HERS Duct Leakage Test - Existing Duct System (Page 2 of 2) Site Address: 56850 MERION (SYS 2), La Quinta CA 92253 (System Enforcement Agency: Permit Number: 1) City of La Quinta 12-0484 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. !.� ®nd retu All supply arn registerboots-inbe,sealed to the drywall.if smoke test is utilized for;�compliance - applies4o duct leakage compliance option 3 (leakage,areduction by 60%) and option`4k(fix all"accessible leaks) described above.? '-- 4 0 New duct`instialrlatIans c-ann'o utilize building cavities asrplenumsbr platform returns m liJeu, of d/u�ctrs.,l 0 Mastic and draw bands must be used in cofnbination 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 responsibifity 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 -SR) 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 beginning October 1, 2010, for all low-rise residential buildings. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) HARRISON ENTERPRISES INC Responsible Person's Name: Responsible Person's Signature: Danielle Garcia banielle Garcia CSLB License: Date Signed: Position With Company (Title): 686310 5/7/2012 Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? ❑ Yes ❑ No Reg: 212-A0022074A-M2100001A-0000 Registration Date/Time: 2012/06/11 20:21:57 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE* CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 5) Site Address: Enforcement Agency: Permit Number: 56850 MERION (SYS 2), La Quinta CA 92253 City of La Quinta 12-0484 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 2 System Location or Area Served Living' 1 0 Yes ❑ No 5/16 inch (8 mm) access hole upstream of evaporative coil in the return plenum and labeled according to Figure in Section RA3.2.2.2.2. . 2 ® Yes ❑ No 5/16 inch (8 mm) access hole downstream of evaporative coil in the supply plenum and labeled according to Figure in Section RA3.2.2.2.2. Yes to 1 and 2 is a pass. Enter Pass or Faill ✓ ® Pass ✓ ❑ Fail STMS - Sensor on,the Evaporator` Coil System Name or identification/Tag S f r System 2-- ? 3 ❑ Yes p No ,/ � The sensor is factory installed, or field installed according to manufacturer's specifications, or isf installed by methods/specifications approved by.the Executive Director. 4 ❑ Yes ❑ No The sensor wire is terminated with.a standard mini plug suitable for connection to a „ digital thermometer. The -sensor mini plug is accessible to the installing techinician - _ - and the HERS rater without changing the airflow through the condenser`eoil` 5 1 Yes 1 ❑ No IThe sensor measures the saturation temperature of the coil within 1.3 degrees F Yes to 3, 4, and 5 is a pass. Enter N/A if STMS are not applicable. Otherwise enter Pass or Fail ✓ 0 N/A ✓ ❑ Pass ✓ ❑ Fail i i STMS - Sensor on the Condenser Coil System Name or Identification/Tag System 2 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 1 ❑ 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 ✓ ❑ Fail applicable. Otherwise enter Pass or Fall Ir Reg: 212-A0022074A-M2500001A-0000 Registration Date/Time: 2012/06/11 20:23:23 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms - - - _ - -- August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5) Site Address: Enforcement Agency: Permit Number: 56850 MERION (SYS 2), La Quinta CA 92253 1 City of La Quint a 12-0484 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 appNcable. • The system should be Installed and charged in accordance with the manufacturer's spec/flcations before starting this procedure. • The system must meet minimum airflow requirements as prerequisite for a valid refrigerant charge test. • If outdoor air dry-bulb is 55°F or below, the installer must use the Alternate Charge Measurement Procedure. Space Conditioning Svstems System Name or Identification/Tag System 2 (must be re -calibrated monthly) Date of Thermocouple,Calibration •I r' 5-1-12 System Location or Area Served Living Outdoor Unit Serial # 1912A29424 Outdoor Unit Make Lennox Outdoor Unit Model 14ACX-036-230 Nominal Cooling Capacity Btu/hr 34400 Date of Verification 5-7-12 Calibration of Diaqnostic Instruments Date of Refrigerant Gauge Calibration 5-1-12 (must be re -calibrated monthly) Date of Thermocouple,Calibration •I r' 5-1-12 (must be recalibrated monthly) Measured Temperaturevur-) ; / , , I -✓I _. I �� ! \ 14 System Name or Identifi'cationrTagSystem 2 Supply (evaporator leaving) air dry-bulb- ry-bulb 52 temperature temperature (Tsupply, db) '1 Return (evaporator entering) air dry-bulb 79 temperature (Treturn, db) .1 Return (evaporator entering) air wet -bulb 59 temperature (Tretum, wb) Evaporator saturation temperature 48 (Tevaporator, sat) Condensor saturation temperature 100 (Tcondensor, sat) Suction line temperature (Tsuction) 62 Liquid Line Temperature (Tliquid) 91 Condenser (entering) air dry-bulb 88 temperature (Tcondenser, db) Reg: 212-A0022074A-M2500001A-0000 Registration Date/Time: 2012/06/11 20:23:23 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms August 2009 G INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5) Site Address: Enforcement Agency: Permit Number: 56850 MERION (SYS 2), La Quinta CA 92253 City of La Quinta 12-0484 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 2 Calculate: Actual Temperature Split = Treturn, 27.00 db - Tsupply, db Target Temperature Split from Table RA3.2-3 24 using Treturn, wb and Tretum, db Calculate difference: Actual Temperature Split - 3 Target Temperature Split = Passes if difference is between -3°F and +3°F or, upon remeasurement, if between -3°F and PASS -100°F Enter Pass or Fai 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�J!�� r- ` System 2 v Calculated Minimum Airflotiv Reruiremert CFM Measured Airflgousing FA .3 procedures 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 System 2 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 Enter Pass or Fail Reg: 212-A0022074A-M2500001A-0000 Registration Date/Time: 2012/06/11 20:23:23 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-25-HER; Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5; Site Address: Enforcement Agency: Permit Number: 56850 MERION (SYS 2), La Quinta CA 92253 City of La Quinta 12-0484 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 2 Calculate: Actual Subcooling = 9.0 Tcondenser, sat - Tliquid Target Subcooling specified by manufacturer 6 Calculate difference: 3 Actual Subcooling - Target Subcooling = System passes if difference is between -3°F and +3°F PASS r �r r, Enter Pass or Fail 4 j 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 2 Calculate: Actual Superheat = 14.0 Tsuction - Tevaporator, sat Enter allowable superheat range from manufacturer's specifications (or use range 25 between 4°F and 25°F if manufacturer's specification is not available) i System passes,if actuaf.superheat is,within,the' '.,PASS r �r r, allowable superheat range r 4 j / ,., Enter Pass or Fail_ - Reg: 212-A0022074A-M2500001A-0000 Registration Date/Time: 2012/06/11 20:23:23 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms v- 'y m- y August2009 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of S) Site Address: Enforcement Agency: Permit Number: 56850 MERION (SYS 2), La Quinta CA 92253 City of La Quinta 12-0484 Standard Charge Measurement Summary: System shall pass both refrigerant charge criteria, metering device criteria (if applicable), and minimum cooling coil airflow criteria based on measurements taken concurrently during system operation. If corrective actions were taken, all applicable verification criteria must be re -measured and/or recalculated. System Name or Identification/Tag System 2 CSLB License: Date Signed: Position With Company (Title): System meets all refrigerant charge and airflow 5/7/2012 Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): requirements. PASS Enter Pass or Fail DECLARATION STATEMENT . I certify under penalty of per)ury, 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 fall 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 -SR 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 realstry for multiple orientation alternatives, and beainnina October 1, 2010, for all low-rise residential buildinas. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) HARRISON ENTERPRISES INC Responsible Person's Name: Responsible Person's Signature: Danielle Garcia banielle Garcia CSLB License: Date Signed: Position With Company (Title): 686310 5/7/2012 Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? 0 Yes ❑ No Reg: 212-A0022074A-M2500001A-0000 Registration Date/Time: 2012/06/11 20:23:23 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms August 2009 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-21 Duct Leakage Test — Existing Duct System (Page 1 of 2) Site Address: Enforcement Agency: Permit Number: 56850 MERION, La Quinta CA 92253 (System 1) City of La Quinta 12-0484 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. 0 1. Measured leakage less than 15% of fan flow 2. Measured leakage to outside less than 10% of Fan Flow I] 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. ✓ ❑ Cooling system method: Size o"f cbndeSser in Tons i `x'400 = CFM] �. r1,7 _ a✓' l ♦! r P! ' + Y ✓ O Heating 21.7% Output Capacity in system method: x _ •TAusands of Stu, hr = _CFM ✓ ❑ Measured system airflow using RA3.3 airflow test; procedures: _ CFM Option 1 used then: ^ ..- ---• +, <. (E • C1' ( � ; 1 Allowed leakage =.Fan Flow x 0.15 = _CFM _` i .• ^ t - Actual Leakage = _ CFM r ----N J Pass if Leakage Actual is less than Allowed Pass p Fall Option 2 used then: i 2 Allowed leakage = Fan Flow l x 0.10 = _ CFM Actual Leakage to outside = _ CFM ' Pass if Leakage Actual is less than Allowed Pass 1p 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 9/6 Reduction > 600/a Pass 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 E3 Pass Fail Reg: 212-A0022073A-M2100001A-M21A Registration Date/Time: 2012/06/11 20:27:31 HERS Provider: Ca10ERTS, 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: Enforcement Agency, Permit Number: 56850 MERION, La Quinta CA 92253 (System 1) City of La Quinta 12-0484 ❑ 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. ❑ All supply�and*return register boots must be;sealed.to;the drywall;if-smoke:test,is utilized -for. compliance' - applies,to duct leakage compliance,opN6n3'(leakage reduction by 60%J�and'optiori*ix all -accessible leaks) descrlbed above. ❑ New duct'installations cannot"utilize building ca//vities as plenums or platform returns,in.lieu of ducts: ❑ Mastic and �draW bands must be'use d inrcombmation'with cloth backed:rubber•adhesiveAuct tape�to seal-'%:OOo 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 -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 Responsible Person's Name: CSLB License: Danielle Garcia 1686310 HERS Provider Data Registry Information Sample Group * (if applicable): 317163 ❑ tested/verified dwelling © not-tested/verified dwelling in la HERS sample group HERS Rater Information CaICERTS Certificate # CCI -1798652170 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: 6/11/2012 CC2004131 Reg: 212-A0022073A-M2100001A-M21A Registration Date/Time: 2012/06/11 20:27:31 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms _ _ - r-� ��— — March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page i of S) 111111111 Site Address: Enforcement Agency: Permit Number: 56850 MERION, La Quinta CA 92253 City of La Quinta 12-0484' 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 SuoDly and Return Plenums of Air Handier System Name or Identlfication/Tag , -CI . 'I 1I f 1 111/61' / — t, -•r r- I I System Location or Area Served �❑ Yes i 1 13Yes [3 N0 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. y Enter Pass or Fail ✓ ❑ Pass ✓ ❑ Fail STMS - Sensor. on the Evaooratoi Coil System Name or Identification/Tag I , -CI . 'I 1I f 1 111/61' / — t, -•r r- I I 3 �❑ Yes i J ❑No The sensor is factory installed, orfield installed according to manufacturer's specifications, or is'lnstalled by method's/specifications approved by the Executive Director. 4 /j C3Yes '[731i,' ❑ No The sensor wire is terminated.with. a standard mini plug suitable for connectionato al digital thermometer. The sensor mini plug is accessible to the installing technioa(i � Director. 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 ✓ ❑ N/A_T ✓ ❑ 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 ❑ 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 When attached to a digital thermometer, the sensor provides an indication of the temperature of the coil. i-1saturation Yes to 6, 7, and 8 is a pass. Enter N/A if STMS are not ✓ ®N/A ✓ ❑Pass ✓ ❑Fail applicable. Otherwise enter Pass or Fail Reg: 212-A0022073A-M2500001A-M25A Registration Date/Time: 2012/06/11 20:29:20 HERS Provider: Ca10ERTS, 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: 56850 MERION, La Quinta CA 92253 City of La Quinta 12-0484 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 far 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 Conditionin4 Svstems System Name or Identification/Tag /! (must be re-callbrated monthly) Date of Thermocouple Calibration P µ •- i System Location or Area Served J. r' Outdoor Unit Serial # Outdoor Unit Make Outdoor Unit Model Nominal Cooling Capacity Btu/hr Date of Verification I OLI... VI W awllubLM AIJJLfuf•ZtlFI[ Date of Refrigerant Gauge Calibration. /! (must be re-callbrated monthly) Date of Thermocouple Calibration P µ •- i ' (must be re -ca rated monthly) J. r' k S stem Name or Identificat ontra y " Ij /! t J !,e PT, Supply (evaporator leaving) air dry-bulb- ry-bulb temperature temperature (T supply, db) Return (evaporator entering) air dry-bulb temperature (Tretum, db) Return (evaporator entering) air wet -bulb temperature (Tretum, cub) Evaporator saturation temperature (Tevaporator, sat) Condensor saturation temperature (Tcondensor, sat) Suction line temperature (Tsuction) Liquid Line Temperature (Tliquid) Condenser (entering) air dry-bulb temperature (Tcondenser, db) Reg: 212-A0022073A-M2500001A-M25A Registration Date/Time: 2012/06/11 20:29:20 HERS Provider: Ca10ERTS, Inc. -�� -� 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-4R-MECH-2i5 Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5) Site Address: Enforcement Agency: Permit Number: 56850 MERION, La Quinta CA 92253 City of La Quinta 12-0484 Minimum Airflow Requirement Temperature Split Method Calculations for determining Minimum Airflow Requirement for Refrigerant Charge Verification. The temperature split method is specified in Reference Residential Appendix RA3.2. System -Name or Identification/Tag Calculate: Actual Temperature Split = Treturn, db - Tsupply, db Target Temperature Split from Table RA3.2-3 using Treturn, wb and Treturn, db Calculate difference: Actual Temperature Split - - Target Temperature Split = Passes if difference is between -4°F and +4°F or, upon remeasurement, if between -4°F and -100°F Enter Pass or Fall - 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-orldentification/Tag Calculated Minimum Airflow Requirement (CFM) 7 } I ��i 4 F. Measured Airflow using RA33r9ced6res CFM)) f f 1 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 -6°F and +6°F Enter Pass or Fail 1 Reg: 212-A0022073A-M2500001A-M25A Registration Date/Time: 2012/06/11 20:29:20 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-4R-MECH-2 Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5) Site Address: Enforcement Agency: Permit Number: 56850 MERION, La Quinta CA 92253 City of La Quinta 12-0484 Subcooling Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag Calculate: Actual Subcooling = Tcondenser, sat - Tliquid Target Subcooling specified by manufacturer Calculate difference: Actual Subcooling - Target Subcooling = System passes if difference is between _ -4°F and +4°F -- , �- t. J T1- Enter Pass or Fail Metering Device Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag Calculate: Actual Superheat = Tsuction - Tevaporator, sat Enter allowable superheat range from manufacturer's specifications (or use range between 3°F and 26'F if manufacturer's specification is not available) _ System passes if actual superheat is'within-the allowable superheat range `f , ` -- , �- t. J T1- % Enter Pass or Faill Reg: 212-A0022073A-M2500001A-M25A Registration Date/Time: 2012/06/11 20:29:20 HERS Provider: Ca10ERTS, Inc. 20.08, Residential Compliance Forms___ � � �_ _ T- March 2010 INSTALLATION CERTIFICATE CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 Of 5) Site Address: Enforcement Agency: Permit Number: 56850 MERION, La Quinta CA 92253 City of La Quinta 12-0484 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 i*e-measured and/or recalculated. System Name or Identification/rag Danielle Garcia 1686310 HERS Provider Data Registry Information Sample Group # (if applicable): 317163 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: 6/11/2012 CC2004131 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 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 agency. Builder or Installer information as shown on the Installation Certificate (CF -611) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) HARRISON ENTERPRISES INC Responsible Person's Name: CSLB License: Danielle Garcia 1686310 HERS Provider Data Registry Information Sample Group # (if applicable): 317163 ❑ tested/verified dwelling not-tested/verified dwelling in a HERS sample group HERS Rater Information CalCERTS Certificate # CC1-1798652170 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: 6/11/2012 CC2004131 Reg: 212-A0022073A-M2500001A-M25A Registration Date/Time: 2012/06/11 20:29:20 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-21 Duct Leakage Test - Existing Duct System (Page 1 of 2) Site Address: 56850 MERION (SYS 2), La Quinta CA 92253 (System Enforcement Agency: Permit Number: i) City of La Quinta 12-0484 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 Leakaqe Diaqnostic Test - existina 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 D 3. Reduce leakage by 60% and conduct smoke and fix all leaks 0 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:+f ,' " ' '•" ✓ Cooling system method: Size of condenser in Tons / x 4,00 = I CFM t f � `' ✓ ❑ Heating system meth�21J Output Capa ty in Thousands Btu/h. = CFM_ x _ of _ E p_1 J : c.- -y, ✓ ❑ Measureds tem airflow using RA3.3 airflow test procedures: ys �� ►% ��'I '�. Option 1 used then:_ - -- -1 - 1 Allowed leakage = Fan Flow x 0.15 = _ CFM Actua I Leakage*= _ CFM ' Pass if Leakage Actual is less than Allowed Pass 0 Fail Option 2 used then: 2 Allowed leakage = Fan Flow I x 0.10 = _ CFM Actual Leakage to outside = _ 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 > 600/6 p Pass 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 C3 Pass 0 Fail 61 . Reg: 212-A0022074A-M2100001A-M21A Registration Date/Time: 2012/06/11 20:27:31 HERS Provider: Ca1CSRTS, 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: 56850 MERION (SYS 2), La Quinta CA 92253 (System Enforcement Agency: Permit Number: 1) City of La Quinta 12-0484 O 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. _r,IN lip 0 All supply and return register boats must be+sealed tot drywall'if, smoke testis utilized for, compliance - applies'to duct leakage compliance option 3 (leakage reduction by -60%) and option *,(fix all`accessible leaks) described above. I t i ❑New duct installations cannot utilize building cavities as;plenumsSor platform returnsTinylieu of uc is '�. f '. • Y- `"'�s"'"�r --7— "r!_: �- , .ter 7u. 0 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 Certificates) 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 -6R) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) HARRISON ENTERPRISES INC Responsible Person's Name: CSLB License: Danielle Garcia 1686310 HERS Provider Data Registry Information Sample Group # (if applicable): 317163 tested/verified dwelling 0 not-tested/verified dwelling in a HERS sample group HERS Rater Information CaICERTS Certificate # CCi-1798652171 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: 6/11/2012 CC2004131 Reg: 212-A0022074A-M2100001A-M21A Registration Date/Time: 2012/06/11 20:27:31 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-2! Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 5) Site Address: Enforcement Agency: Permit Number: 56850 MERION (SYS 2), La Quinta CA 92253 City of La Quinta 12-0484 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 Suupiv and Return Plenums of Air Handler System Name or Identification/Tag 3 System Location or Area Served �In ❑ No 1 ❑ Yes ❑ No 5/16 inch (8 mm) access hole upstream of evaporative coil In the return plenum and labeled according to Figure in Section RA3.2.2.2.2. 2 ❑ Yes ❑ No 5/16 inch (8 mm) access hole downstream of evaporative coil in the supply plenum and labeled according to Figure in Section RA3.2.2.2.2. Yes to 1 and 2 is a pass. , Enter Pass or Faill ✓ ❑ Pass ✓ ❑ Fail STMS - Sensor.on the Evaporator Coil _ System Name or Identification/Tag ,. 1 ` / i. 1 , �,� f - ti r , 1: 3 f13 Yes �In ❑ No The sensor is factory" installed, orlfield,installed according to manufacturer's specifications, or Oinstalled by methods/specifications approved by the Executive 6 ❑ Yes ,� specifications, or is installed by methods/specifications approved by the Executive ! - Director. r ' �FI i The sensor wire is terminated, With a standard mini plug suitable for connection to as 4 ❑Yes< ❑ No digital. thermometer. The sensor mini plug is accessible to the installing teciiniciank,�,, -- 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. i-1} Yes to 3, 4, and 5 is a pass. Enter N/A if STMS are not / ❑ N/A ✓ ❑ Pass ✓ ❑ Fail applicable. Otherwise enter Pass or 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 ❑ 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 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 ® N/A ✓ ❑ Pass ✓ ❑ Fail applicable. Otherwise enter Pass or Fail Reg: 212-A0022074A-M2500001A-M25A Registration Date/Time: 2012/06/11 20:29:20 HERS Provider: Ca10ERTS, 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: 56850 MERION (SYS 2), La Quinta CA 92253 City of La Quinta 12-0484 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 farm. Attach an additional fnrm(s) for any additional systems /n the dwelling as applicable. • The system should be Installed and charged In accordance with the manufacturers 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 Systems System Name or Identification/Tag (must be re -calibrated monthly) Date of Thermnocouple,Calibration r 7 System Location or Area Served Outdoor Unit Serial # Outdoor Unit Make Outdoor Unit Model Nominal Cooling Capacity Btu/hr Date of Verification a 011UFauun WN apiaynusuc anscruments Date of Refrigerant Gauge Calibration (must be re -calibrated monthly) Date of Thermnocouple,Calibration r 7 _(must be re calibrated monthly) rieasurea Temperatures (,-r) -I , f I , . 't'r, I -C i 'A % L+, a r System Name or Identifificatirton./Tag Supply (evaporator leaving) air dry-bulb temperature (Tsupply, db) .I Return (evaporator entering) air dry-bulb temperature (Treturn, db) 1 Retum (evaporator entering) air wet -bulb temperature (Treturn, wb) Evaporator saturation temperature (Tevaporator, sat) Condensor saturation temperature (Tcondensor, sat) Suction line temperature (Tsuction) Liquid Line Temperature (Tliquid) Condenser (entering) air dry-bulb temperature (Tcondenser, db) Reg: 212-A0022074A-M2500001A-M25A Registration Date/Time: 2012/06/11 20:29:20 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5) Site Address: Enforcement Agency: Permit Number: 56850 MERION (SYS 2), La Quinta CA 92253 City of La Quinta 12-0484 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 = Tretum, db - Tsupply, db Target Temperature Split from Table RA3.2-3 using Treturn, wb and Treturn, db Calculate difference: Actual Temperature Split - Target Temperature Split = Passes if difference is between -4°F and +4°F or, upon remeasurement, if between -4°F and -100°F Enter Pass or Fail Note: Temperature Split Method Calculation is not necessary if actual Cooling Coil Airflow is verified using one of the airflow measurement procedures specified in Reference Residential Appendix RA3.3. If actual cooling coil airflow is measured, the value must be equal to or greater than the Calculated Minimum Airflow Requirement in the table below. Calculated Minimum Airflow Requirement (CFM) = Nominal Cooling Capacity (ton) X 300 (cfm/ton) System Na a or Ide ntification/Tag 7 `*'---1071 " �• JJ'� s !! Calculate6 Minimum Airflow�Requiremert (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 -6°F and +6°F Enter Pass or Fail Reg: 212-A0022074A-M2500001A-M25A Registration Date/Time: 2012/06/11 20:29:20 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: 56850 MERION (SYS 2), La Quinta CA 92253 City of La Quinta 12-0484 Subcooling Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag Calculate: Actual Subcooling = Tcondenser, sat - Tliquid Target Subcooling specified by manufacturer Calculate difference: Actual Subcooling - Target Subcooling = System passes if difference is between -4°F and +4°F r rA r4 c'- 1`41" Enter Pass or Fail Metering Device Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag Calculate: Actual Superheat = Tsuction - Tevaporator, sat Enter allowable superheat range from manufacturer's specifications (or use range between 3°F and 26°F if manufacturer's specification is not available) '' System,passesif actual superheat is`within°tiie _ allowable superheat range r rA r4 c'- 1`41" f ,-J Enter Pass or FailA. r Reg: 212-A0022074A-M2500001A-M25A Registration Date/Time: 2012/06/11.20:29:20 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 4 INSTALLATION CERTIFICATE CF-411t-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5) Site Address: Enforcement Agency: Permit Number: 56850 MERION (SYS 2), La Quinta CA 92253 City of La Quinta 12-0484 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 1686310 HERS Provider Data Registry Information Sample Group # (if applicable): 317163 System meets all refrigerant charge and airflow not-tested/verified dwelling in FR ERS sample group requirements. HERS Rater Company Name: Energy Driven Solutions, Inc. Responsible Rater's Name: Responsible Rater's Signature: Enter Pass or Fail David Br4cker Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: .6/11/2012 CC2004131 V 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) compiles 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 -111) approved by the enforcement aaency. Builder or Installer information as shown on the Installation Certificate (CF -611) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) HARRISON ENTERPRISES INC Responsible Person's Name: CSLB License: Danielle Garcia 1686310 HERS Provider Data Registry Information Sample Group # (if applicable): 317163 ID tested/verified dwelling not-tested/verified dwelling in FR ERS sample group HERS Rater Information CaICERTS Certificate # CCl-1798652171 HERS Rater Company Name: Energy Driven Solutions, Inc. Responsible Rater's Name: Responsible Rater's Signature: David Bricker David Br4cker Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: .6/11/2012 CC2004131 Reg: 212-A0022074A-M2500001A-M25A Registration Date/Time: 2012/06/11 20:29:20 HERS Provider: Ca10ERTS, Inc'. 2008 Residential Compliance Forms March 2010