Loading...
MECH (12-0064)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number:' Property Address: APN: Application description Property Zoning: Application valuation: 12-000;0006 _49755 AVENIDA MONTERO 646-181-012- - - MECHANICAL LOW DENSITY RESIDENTIAL' 12437' BUILDING & SAFETY DEPARTMENT BUILDING PERMIT ' Owner: KIRBY TOM 49755 AVENIDA MONTERO LA QUINTA, CA 92.253 J VOICE (760) 777-7012. FAX -(760) 777-7011 INSPECTIONS (760) 777-7153 Date: 1/24/12 _ U JA,N 2 z 22fliq lli�j Date: Owner: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the ,... r6. f: -,r -:,Eich this permit is issued (Sec. 30S7, Civ. C.). ' Lender's Address: l - LQPERMIT 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 ermit, or cessation of work for 180 days will subject, permit to cancellation. I certify that I have read this application and state that the ve information is correct. I agree to comply with all city and county ordinances and state laws relating tobuilt construction, and hereby authorize representatives of th, counry to enter upon tl above-mentioned proper r insp 'on purposes. Jdte: Z4 Si nature (Applicant or AyenU: 1 Engineer: Contractor: GENERAL AIR CONDITIONING i Ghry� A:�Jiyp Applicarit: Architect or Frr��,z 31170 RESERVE DRIVE THOUSAND PALMS, CA 92276 (760)343-7488 Lio. No.: 686310 -- - - - - - - - - - - - - - - -- - - LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION . I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations: Section 7000) of Division 3 of the Business and Profession Code, and,my License is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided Lice se Class: C20 icense tVo.: 686310 \ Date:—'T ntractor: 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 ' - 0 - ILDER DECLARATION - insurance carrier and policy number are: - I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier ZENITH INS CO Policy Number . Z071741501 ' following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to _ I certify that, in the performance of the work for which this permit is issued, I shall not employ any - construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to become subject the workers' compensation laws of California, permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I should become subject to workers' compensation provisions of Section License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or - 3700 of the Labor Code, I shall forthwith co y with those provisions. 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 IS5001.: -_:7�1r A scant: - ( 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 WARNING: FAILURE TO SECURE WORKERS' COMPENSA ON COVERAGE IS UNLAWFUL, AND SHALL Contractors' State License Law does not apply to an owner of property who builds or improves thereon, ' SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL -FINES UP TO ONE HUNDRED THOUSAND - and who does the work himself or herself through his or her own employees, provided that the DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE. LABOR CODE, INTEREST, AND ATTORNEY'S FEES. " 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.). APPLICANT ACKNOWLEDGEMENT (_ I 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the 7044, Business.and Professions Code: The Contractors' State License Law does not apply to an owner of - conditions and restrictions set forth on this application. property who builds or improves -thereon, and who contracts for the projects with contractor(s) licensed 1 : Each person upon whose behalf this application is made, each person at whose request and for 'pursuant to the Contractors' State License Law.). - - whose benefit work is performed under or pursuant to any permit issued as a result of this application, (_) I am exempt under Sec. B.&P.C: for this reason 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 " Date: Owner: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the ,... r6. f: -,r -:,Eich this permit is issued (Sec. 30S7, Civ. C.). ' Lender's Address: l - LQPERMIT 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 ermit, or cessation of work for 180 days will subject, permit to cancellation. I certify that I have read this application and state that the ve information is correct. I agree to comply with all city and county ordinances and state laws relating tobuilt construction, and hereby authorize representatives of th, counry to enter upon tl above-mentioned proper r insp 'on purposes. Jdte: Z4 Si nature (Applicant or AyenU: Application Number . . . . . 12-00000064 - Permit MECHANICAL . Additional desc . Permit Fee . . . . 40.50 Plan Check Fee 10.13, Issue Date . . . . Valuation 0. . Expiration Date : 7/22/12 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/d >3-15HP/>100K-500KBTU 16.50 Special Notes and Comments HVAC CHANGE -OUT: 4 TON SYSTEM, FURNACE, CONDENSER & INDOOR COIL. 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 51.6'3 .00 .00 Simlified Prescri tive Certificate of Compliance:- 2008. Residential HVACAIterations CF -IR -ALT -HVAC Climate Zones 10 to 15 Site Address:�� rJ ��t l f Enforcement Agency: Date:I' Permit: " dol go I. —T Conditioned Floor Equipment T et List Minimum Efficiency Z Duct insulation requirement Area Thermostat ❑�Packaged Unit 6—'Furnace IZ / AFUE 80% ❑ COP Over 40 ft of ducts added or XSetback 9' door Coil 6}�SF R !3 ❑ HSPF _ replaced in unconditioned space Served by system (1/'nor already Condensing Unit Qiftlt / / ❑ Resistance ❑ R 6 (CZ 10-13) V03 0 sf present, must 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-HVACfvr each system. 2. Minimum Equipment Efficiencies: 13 SEER, 78% AFUE, 7.7HSPFJor typical residential systems. HERS VERIFICATION SUMMARY Listed below are fottrHVAC 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 fI ed. Be innin October 1, 201.0, a re istered co of the CF -IR and CF -6R shall also be on site for final ins ection. . HVAC Changeout Required Forms: } r CF -6R forms: MECH-04, MECH-2I-HERS and o A11 -HVAC Equipmentreplaced(tbr split syste CF -4R forms: MECH- 21 and fors flits stems MECH-2'S • Condenser Coil and /or • Indoor Coil and/or CF -6R forms: MECH-2I-HERS and (for split systems) MECH- 25 -HERS Furnace CF -4R forms: MECH- 21 and (for split systems) MECH-25 • For Split Systems: Duct leakage < 15 percent; RC, CCA > 300 CFM/ton(Minimum Air Flow Requirement), TMAH For Packaged Units: Duct leakage < 15 percent Exempted from duct leakage testing if.. ❑ I. Duct system was documented to have been previously sealed and confirmed through HERS verification, or ❑ 2. Duct systems with less than 40 linear feet in unconditioned space, or ❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos ❑ 2. New HVAC System Required Forms: • Cut s: al Chang outducting 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 new equipment) CF -4R forms: MECH 20-, and (for split systems)MECH-22, and MECH 25 For Split Systems: Duct leakage < 6 percent; RC, CCA > 350 CFM/ton, FWD, TMAH, STMS, and either HSPP or PSPP. For Packaged Units: Duct leakage < 6 percent ❑ 3. New Ducts with Replacement Required Forms: • Includes replacing or installing all new ducting CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-25-HERS and/or outdoor condensing unit and/or indoor CF -4R forms: MECH-20 and (for split systems) MECH-25 coil and/or 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: MECH-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 ducts stems 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 pylic ompiiance forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for appro at with t e cnnit application. Name: �r!Lpe�l U/QSi tures Company: e- , Date: Gen�a.( tot� r COi4de f,o�I, Address: 311 7D keser^Ue License: l�t� �>✓ �8�3iv [EC—ity/Statc/Zip:—�—�� � �� � Gly 9'Phone: 74,0..31"3-74eeP r Public Home'Danielle Garcia logged in [Logout] - � ` _ � , • [Home] Secure Home r CONGRATULATIONS About Us + - Your CF-IR-ALT-HVAC Registration is complete! You may want to print this page for your records. Training - � � . • . 1. - Site Address 49755 AVENIDA + Rater Directory • La Quinta, CA 92253 CEC Registration: 212-A0003869A-00000000-0000 Forms CF-IR-ALT-HVAC: CLICK HERE TO DOWNLOAD Assigned Company: HARRISON ENTERPRISES INC Membership Benefits .................. _._.._....._................................._..........._............._.........._......._....._.._......_............................._........ _._.. _. - Even , Do you know your HERS Rater? _ _ _ - — _ .".,.._.Ifyou•do, youmay-want-to send-this-CF-411 to•thern - + Industry Partners CaICERTS Rater ID: I 4• OR News My Rater Quick Select: ;,--Select From List Every CaICERTS rater has a license number. To register for our t !f you need to find the rater by name Click HERE to search our directory. monthly SEND CF 1R TONERS RATERS newsletter, please Click here. [CLICK HERE] to do another Copyright,,O 1_010 CaICERTS, [tic. All rights reserved. Revised: January 11, 2010 t [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'l Fbna us on FaCebookQ4:; ,�, _ � • Bin # - CV of la Quinta ' • Building 81:' Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and. Tracking Sheet Permit # Project Address: Men' o . Owner's Name: TO Mr A. P. Number: Address: W � o Legal Description: City, ST, Zip: � A u/ � � I l � � -CA Contractor:co Telephone 11 3 •s r f r.: fi ry Address: 3 y City, ST, Zip: Telephone: .::;cy State Lic. # : 3 City Lic. #: &0 w L Project Description: V G I d C f : IInn rn Arch., Engr., Designer: Address: Telephone:' :•�,�• `•`,�,:r f,z:: ;: � •' `>%<%s''h'':n! k%�z�,,f'• � - Construction Type: Occupancy: ` State Lic. #: ,' Project'type (circle on New , Add'n . Alter Repair Demo a ` Sq. Ft : (v3 U # Stories: I #Units: Name of Contact Person:n CSO G� cicc%f 5 c7Xt� Telephone # of Contact Person: -7& D 3 C3 -7 �� Estimated Value of Project: 23' 1-1.00 APPLICANT: DO. NOT WRITE. BELOW THIS LINE # Submittal Req'd Rec'.d TRACIMG PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cafes. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Title 24 Calcs. Plans picked upConstruction Flood plain plan Plans resubmitted Mechanical Grading plan 2"' Review, readyfor 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 HOUSE:- 'rd Review,.ready for correctionsrssue Developer Impact Fee Planning Approval Called Contact Person A.LP.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees Kirby 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: 49755 AVENIDA, La Quinta CA 92253 (System 1) City of La Quinta 12-64 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 ❑ 2. Measured leakage to outside,less than 10% of Fan Flow ❑ 3. Reduce leakage by 60% and conduct smoke and fix all leaks 3 ❑ 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 nommak Fan Flow using one -of the -following three -calculation -methods. -- ✓ ❑ Cooli*s'ystem method: Size o{f condenser inTons_.x 400 = CFM 'Tr ✓ 13Heating system method 21 7�x -Output Capacity in Thousands of Btu/hr= 11 CFM %0'0 Measured systemai Flow using RA3.3 airflow,testf rocedures:_ CFM Option 1 -used them- hen 1 1 Allowed leakage — Fan Flow _ x 0.15 _ CFM Actual Leakage= _ CFM --------- Pass if Leakage Actual is less than Allowed Pass Fail Option 2 used then: 2 Allowed leakage = Fan, Flow _ x 0.10 = _ CFM Actual Leakage to outside = CFM Pass if Leakage Actual is less than Allowed Pass 0 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 from system. Including ducts, plenums, air handler and door panel. Pass if all accessible leaks have been repaired using smoke Pass Fail Reg: 212-A0003869A-M2100001A-M21A Registration Date/Time: 2012/02/06 20:42:05 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:Enforcement Agency: Permit Number: 49755 AVENIDA, La Quinta CA 92253 (System 1) City of La Quinta 12-64 Builder or Installer information as shown on the Installation Certificate (CF -6111) Company Name: (Installing Subcontractor or General Contractor or B_ uilder/Owner) r Responsible Person's Name: CSLB License: Danielle Garcia 1686310 , HERS Provider Data Registry Information Sample Group # (if applicable): 278137 ❑ tested/verified dwelling 0 not-tested/verified dwelling in a HERS sample group Builder or Installer information as shown on the Installation Certificate (CF -6111) Company Name: (Installing Subcontractor or General Contractor or B_ uilder/Owner) HARRISON ENTERPRISES INC Responsible Person's Name: CSLB License: Danielle Garcia 1686310 , HERS Provider Data Registry Information Sample Group # (if applicable): 278137 ❑ tested/verified dwelling 0 not-tested/verified dwelling in a HERS sample group HERS Rater Information CalCERTS Certificate # CCl-1798624552 HERS Rater Company Name: 41 ❑ Outside air (OA) ducts for Central:Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off Responsible Rater's Name: during duct leakage testing:•CFT„OA ducts that utilize controlled motorized dampers,.that open only when,OA ' ventilation -is, req uired to meet ASHRAE Standard 62.2, and close when OA ventilation is not required, may Responsible Rater's Certification Number w/ this HERS Provider: be' configured to the closed position` during duct leakage testing. ; r ❑ All supply�andrreturn register boots-must;be,,sealed-toAhe�dry}walllKif smokertesttislutllizedifor�.compliance T r - applies to duct leakage compliancedoption.3r(leakage reduction by 60%) and�"option 4"Mwal'I accessible leaks) gdibed abbve ❑ New duct installations cannotiutilize building cavities -as plenums or platform returns fnmeu of ductsn- kq,p ' ❑ MastiCar dWaWlbands must be,used `in*combinationrwlth cloth backedirubber adhesiuexduct tape#to seal leaks,: -6t all'-new:dti`ct"connections° ..� , 1 DEGLARATION'STATEMENT ;' '• - . I certify under penalty of perjury, uderthelaws 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). r" . The installed feature, material, component, or manufactured device requiring HERS verification that is identified on this certificate (the installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified on the Certificate(s) of Compliance (CF -111) approved by the local enforcement agency. . The information reported on applicable sections of the Installation Certificate(s) (CF -611), signed and submitted by the person(s) responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -111) approved by the Y� enforcement agency. Builder or Installer information as shown on the Installation Certificate (CF -6111) Company Name: (Installing Subcontractor or General Contractor or B_ uilder/Owner) HARRISON ENTERPRISES INC Responsible Person's Name: CSLB License: Danielle Garcia 1686310 , HERS Provider Data Registry Information Sample Group # (if applicable): 278137 ❑ tested/verified dwelling 0 not-tested/verified dwelling in a HERS sample group HERS Rater Information CalCERTS Certificate # CCl-1798624552 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: 1/4/2012 CC2004131 F Reg: 212-A0003869A-M2100001A-M21A Registration Date/Time: 2012/02/06'20:42:05 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms .. March 2010 CERTIFICATE.OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 5) Site Address: Enforcement Agency: Permit Number: 49755 AVENIDA, La Quinta CA 92253 City of La Quinta 12-64 Note: If installation of a Charge Indicator Display (CID) is utilized as an alternative to refrigerant charge verification for compliance, a MECH-24 Certificate (instead of this MECH-25 Certificate) should be used to demonstrate compliance with the refrigerant charge verification requirement. TMAH and STMS are not required for compliance, when a CID is utilized for compliance. As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional form(s) for any additional systems in the dwelling as applicable. Temperature Measurement Access Holes (TMAH) and Saturation Temperature Measurement Sensors (STMS) Procedures for installing TMAH are specified in Reference Residential Appendix RA3.2. If refrigerant charge verification is required for compliance, TMAH are also required for compliance. STMS are only required for completely new or replacement space -conditioning systems that utilize prescriptive compliance method. TMAH - Access Holes in Supply and Return Plenums of Air Handler System Name or Identification/Tag System Location or Area Served 1 ❑ Yes ❑ No 5/16 inch (8 mm) access hole upstream of evaporative coil in the return plenum and labeled according to Figure in Section RA3.2.2.2.2. 2 ❑ Yes [],No 1> 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 land 2 i a pass.;.` Enter Pass or Faill ✓ ❑Pass ✓ ❑Fail STMS'- Sensor onTthe. Evaporator,Coil :_..e SystemNarrferorlderiti The sensor is factory installed, or field installed according to manufacturer's The sensor is factory installed, orifield installed' according to ­manufacturer s 3 ❑ Yes �❑-No : specifications, or is installed by methods/specifications approved by the Executive t .a�` l j Director. F The sensor wire is terminated with a standard mini plug suitable for connection to a ,The sensor wire is terminated -with a standard mini plug suitable for connectionto al 4 ❑Yes , _r: ❑:No digital;ttiermorrieter.";Thesensor mini plug,isaccessible to=the installing teclinieian and the HERS rater without changing the airflow through the condenser coil 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. saturation temperature of the coil. Yes to 3, 4, and 5 is a pass. Enter N/A if STMS are not ✓ ❑ N/A ✓ ❑Pass ✓ Fail applicable. Otherwise ente�•Pass or Fail ,y 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 V ® N/A ✓ [3 Pass ✓ [3 Fail applicable. Otherwise enter Pass or Fail Reg: 212-A0003869A-M2500001A-M25A Registration Date/Time: 2012/02/06 20:43:57 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: 49755 AVENIDA, La Quinta CA 92253 City of La Quinta 12-64 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 -T (must be re -calibrated monthly) Date of Thermocouple `Calibration' e0 Ii. ] i System Location or Area Served e } Outdoor Unit Serial # Outdoor Unit Make Outdoor Unit Model Nominal Cooling Capacity Btu/hr . r-- ;i Date of Verification w-miurailon oi'Ulagnosxic 1nsxrumenxs Date of Refrigerant Gauge Calibration -T (must be re -calibrated monthly) Date of Thermocouple `Calibration' e0 Ii. ] i (must be re -calibrated monthly) e } measurea temperatures -t ,r i r I I o . F j _.. % ,;. System Name or Id/ent fication/Tag e } Supply (evaporator leaving)^air-dry-bulb- temperature (TsuPPIY, db) Return (evaporator" "entering) air dry-bulb temperature(Treturn,-db) I 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) Condenser (entering) air dry-bulb temperature (Tcondenser, db) Reg: 212-A0003869A-M2500001A-M25A Registration Date/Time: 2012/02/06 20:43:57 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-411-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5) Site Address: Enforcement Agency: Permit Number: 49755 AVENIDA, La Quinta CA 92253 City of La Quinta 12-64 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 - Tsup ply,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,,Name or Identification/Tag d Calculated Minimum Airflow'Requirerr`ment (CFM) , Measured Airflow u/sing RA3.3 procedures (CFM) f J ,!' .l Passes if measuredairflow is -greater -than or equal!-,. to the calculatedminimum 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-A0003869A-M2500001A-M25A Registration Date/Time: 2012/02/06 20:43:57 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE A CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5) Site Address: Enforcement Agency: Permit Number: 49755 AVENIDA, La Quinta CA 92253 City of La Quinta . 12-64 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.- ystems.System SystemName or Identification/Tag j. Calculate: Actual Subcooling = , Tcondenser, sat - Tliquid ti INSTALLATION CERTIFICATE A CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5) Site Address: Enforcement Agency: Permit Number: 49755 AVENIDA, La Quinta CA 92253 City of La Quinta . 12-64 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.- ystems.System SystemName or Identification/Tag Calculate: Actual Subcooling = , Tcondenser, sat - Tliquid ti Target Subcooling specified by, manufacturer Calculate difference: - ' Actual Subcooling - Target Subcooling = - ' System passes if difference is between -4°F and +4°F a Enter Pass or Fail k ,- -• 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 Identificatidn/Tag k� Calculate: Actual Superheat ti Tsuction - Tevaporator, sat Enter allowable superheat range from; manufacturer's specifications (or use range - between 3°F and 26°F if manufacturer's F ' specification is not available) System passes if actual'superheat is within the' allowable s"uperheat range a �. Enter.Pass or Fail k ,- -• .. t K 4 k01 4 Reg: 212-A0003869A-M2500001A-M25A Registration Date/Time: 2012/02/06 20:43:57 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 1^ k� ti .. t K 4 k01 4 Reg: 212-A0003869A-M2500001A-M25A Registration Date/Time: 2012/02/06 20:43:57 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-4R-MECH-25 Refrigerant Charge Verification_- Standard Measurement Procedure (Page 5 of 5) Site Address: Enforcement Agency: Permit Number: 49755 AVENIDA, La Quinta CA 92253 City of La Quinta 12-64 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 t Sample Group# (if applicable): 278137 System meets all refrigerant charge and airflow 0 not-tested/verified dwelling in la 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: 1/4/2012 - ,fir r.. � t ," k F 0$�,3.,•xt SpSy�/y; ' .. "".f°°'.••`+. •...,,_�,"_ 1»a� ` Y:_.' 3e � * J4. i SQi3. Y"q�'`s "h+*x: ' p«..n+x^"..a.•' —� . ,,,,f.•.--.w+""'"� i .'. ; tiro + e DECLARATION STATEMENT i . ,I certify under penalty of perjuryunder,the laws of the State of California, the information provided on this form is true and correct. . I am the certified HERS rater who performed the verification services identified and reported on this certificate (responsible rater). . The installed feature, material, component, or manufactured device requiring HERS verification that is identified on this certificate (the installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified ' on the Certificate(s) of Compliance (CF -111) approved by the local enforcement agency. . The information reported on applicable sections of the Installation Certificate(s) (CF -611), signed and submitted by the person(s) responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -111) approved by the enforcement agency. e 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 + 1686310 HERS Provider Data Registry Information Sample Group# (if applicable): 278137 Q tested/verified dwelling 0 not-tested/verified dwelling in la HERS sample group HERS Rater Information CaICERTS Certificate # CC1-1798624552 - 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: 1/4/2012 CC2004131 Reg: 212-A0003869A-M2500001A-M25A Registration Date/Time: 2012/02/06 20:43:57 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms �� March 2010 CERTIFICATE OF FIELD VERIFICATION &'DIAGNOSTIC TESTING CF-411-MECH-21 Duct Leakage Test —Existing Duct System (Pagel of 2) Site Address: 49755 AVENIDA (Sys 2), La Quinta CA 92253 (System Enforcement Agency: Permit Number: 1) City of La Quinta 12-64 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 ;. lJ 2. Measured leakage to outside less than 10% of Fan Flow ' 0 3. Reduce leakage by,60% and conduct smoke and fix all leaks 4;, Fixall' accessible leaks using smoke and HERS rater verify Note: (One of Opt ons_ 1, 2, or 3 must be.attempted#before,util zing Option,4,),,- Determine nominal Fan Flow using one ofvthe'following three'calcula4— X11tion methods , ' 6 ❑Cooling system method: Size of condenser in Tons ✓ Heating" system method: Z-1.1 x" # Output Capacity0n Thousands of Btu/hr = CFM s •. ' ✓ 0Measureds,.ystem airflow using�RA3 3 airflow test procedures:= CFM;; � Option '1 used '_then: 1 Allowed leakage = Fan'Flow LIVIx 0:15 CFM r Actual Leakage _ CFM e F* - -.�' ;,• Pass if Leakage Actual is less than Allowed Pass Fail Option 2 used then .x , 2 Allowed leakage Fan Flow x 0.10 = _ CFM - Actual Leakage to outside , 7- CFM ..` 3; 'Pass if Leakage Actual is less than Allowed Pass Fail Option 3 used then: Initial leakage prior to startof work = CFM , Final leakage after sealing all accessible leaks using smoke test = CFM Y 3 Initial leakage _ - Final leakage _ = Leakage reduction _ CFM, ((Leakage reduction _ / Initial leakage _) x 100% _ % Reduction ` n 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 from system. Including ducts, plenums, air handler and door panel. Pass if all accessible leaks have been repaired using smoke a Pass Fail Reg: 212-A0005868A-M2100001A-M21A Registration Date/Time: 2012/02/06 20:42:06 a HERS Provider:,Ca10ERTS, Inc. 2008 Residential Compliance Forms „, i" March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-21 .,;, Duct Leakage Test - Existing Duct System (Page 2 of 2) Site Address: 49755 AVENIDA (Sys 2), La Quinta CA 92253 (System Enforcement Agency:, Permit Number: 1) A 12-64 r� not-tested/verified dwelling in la HERS sample group HERS Rater Information CaICERTS Certificate # CC1-1798627077 HERS Rater Company Name:,, ! 4 Energy Driven Solutions, Inc. 1 i Responsible Rater's Name: • Responsible Rater's Signature: David Bricker • David Bricker Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 1/4/2012 ' CC2004131 • CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-21 « Duct Leakage Test - Existing Duct System (Page 2 of 2) Site Address: 49755 AVENIDA (Sys 2), La Quinta CA 92253 (System Enforcement Agency:, Permit Number: 1) City of La Quinta 12-64 r� ❑ Outside.air (OA) duetil ts for Central Integrated (CFI) venation 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 requ.ired.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 - appliesto;duct leakage compliance option 3 (leakage reduction by`60%) and option 4 (fixall accessible leaks described above ❑ New duct installations cannot<utilize buildm"g cavities asplenumsorplatform returns in lieu of ducts/ 3 " K,•,• r �,. _ ❑ Mastic andadraw bands`:must b,e used i;n combination with .cli oth backed rubber adhesiWductaape to seal , leaks at all new duct connections} DECLARATION STATEMENT • I certify under penalty of perjuryunder the laws of the State of California, the information provided on this form is true and correct. .I am the certified HERS rater who, pierforrned the verification services identified and reported on this certificate (responsible rater). ; The installed feature, material,component, or manufactured device requiring HERS verification that is identified on this certificate (the installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified on the Certificate(s) of Compliance (CF -111) approved by the local enforcement agency. .• The information reported on applicable sections of the Installation Certificate(s) (CF -611), signed and submitted by the person(s) .responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -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 J Responsible Person's Name: CSLB License: • - Danielle Garcia 686310 HERS Provider Data Registry Information Sample Group # (if applicable): 278137 ❑ tested/verified dwelling • not-tested/verified dwelling in la HERS sample group HERS Rater Information CaICERTS Certificate # CC1-1798627077 HERS Rater Company Name:,, ! 4 Energy Driven Solutions, Inc. 1 i Responsible Rater's Name: • Responsible Rater's Signature: David Bricker • David Bricker Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 1/4/2012 ' CC2004131 • J' • .r Reg: 212-A0005868A-M2100001A-M21A ,Registration Date/Time: 2012/02/06 20:42:06 HERS Provider: Ca10ERTS, Inc.. 2008 Residential Compliance Forms-., • } « March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING . CF-411-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 5) Site Address: Enforcement Agency: Permit Number: 49755 AVENIDA (Sys 2), La Quinta CA 92253 City of La Quinta 12-64 Note: If installation of a Charge Indicator Display (CID) is utilized as an alternative to refrigerant charge verification for compliance, a MECH-24 Certificate (instead of this MECH-25 Certificate) should be used to demonstrate compliance with the refrigerant charge verification requirement. TMAH and STMS are not required for compliance, when a CID is utilized for compliance. As many as 4 systems in the dwelling can be documented for compliance using this form.. Attach an additional form(s) for any additional systems in the dwelling as applicable. Temperature Measurement Access Holes (TMAH) and Saturation Temperature Measurement Sensors (STMS) Procedures for installing TMAH are specified in Reference Residential Appendix RA3.2. If refrigerant charge verification is required for compliance, TMAH are also required for compliance. STMS are only required for completely new or replacement space -conditioning systems that utilize prescriptive compliance method. TMAH - Access Holes in Supply and Return Plenums of Air Handler System Name or Identification/Tag System Location or Area Served f , , 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 1 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 land 2 is apass. i; Enter Pass or Fail ✓ [3 Pass ✓ ❑Fail STMS'- Sensor onathe, Evaporator -Coil Syste'm'Narn`e,& Identification/Tag-p. f , , The sensor is factory installed orifield installed'according`to manufacturers.._., 'specifications, 3 (13.Yes E No ' or is installed by methods/`specifications approved by the Executive �. Director. n' It :._ The sensor wire is terminated --with a standard :mini plug suitable for connectionto a 4 ❑ Yes ,;,�, _ O. -No digital ;thermometer,, the `sensor mini plug is accessible to the ,installmgttechrrieian and"the' HERS rater without changing the airflow through the condenser coil 5 :- ❑)(q;7-tiry ,. ❑ No ]saturation. When attached to a digital thermometer, the sensor provides an indication of the temperature of the coil. 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 ✓ E3 Pass ✓ ❑Fail applicable. Otherwise enter Pass or Fail Reg: 212-A0005868A-M2500001A-M25A Registration Date/Time: 2012/02/06 20:43:58 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 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 y A 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.- - pplicable.• 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 # . 4 System Location or Area Served Date of The mocou a Calibration p .)� M ` kry M •• Outdoor Unit Serial # a Outdoor Unit Make ` y , 1. ..,iw Outdoor Unit Model ' Nominal Cooling Capacity Btu/hr `tt' Return (evaporator entering) air wet -bulb Date of Verification t Calibratioin'of Diagnostic Instruments Date of Refrigerant Gauge Cali ratio a (must be re -calibrated monthly). 4 Date of The mocou a Calibration p .)� M ` kry M " � i ,(must be re -calibrated monthly) Supply'(evaporator'leaving) air drybulb a Measured Temperatures!(f )- a x '' `.* ," `�' '' � .= i - i — - • ,;„ System Name or Identification/Tag 4 L Supply'(evaporator'leaving) air drybulb a Measured Temperatures!(f )- a x '' `.* ," `�' '' � .= i - i — - • ,;„ System Name or Identification/Tag Supply'(evaporator'leaving) air drybulb a temperature (Tsiipply Ddb) ` y , 1. ..,iw Return (eevaporator'entering) air dry-bulb., temperature'(Tretum Return (evaporator entering) air wet -bulb temperature (Treturn, wb) t 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, condenser, db) Reg: 212-A0005868A-M2500001A-M25A Registration,Date/Time: 2012/02/06 20:43:58 .•HERS•Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms,, ; s March 2010 INSTALLATION .CERTIFICATE CF74R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5) Site Address: Enforcement Agency:712-64 Permit Number: 49755 AVENIDA (Sys. 2), La Quinta CA 92253 City of La Quinta 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 - Tsu I db Target Temperature Split from Table RA3.2-3 using Treturn, wb and Treturn, db '` • y Calculate difference: Actual Temperature Split - Target Temperature Split = ' Passes if difference is between -40F and +40F or, upon remeasurement, if between -40F and -1000F' , ,. -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 equaf.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 Name9orl8entification/Tag,, ,i,�. ..,-.. - � f � SFr �. Calculated Minimum AirflowvRequttirement (CF x ° sM) � s ` .„„,ri:...'+• MeasuredAirflowusing RA3.3 procedures (CFM `i t �s _ ,�:r"F..! r 01 . ' •s. �'cT': ' C `'. ' n.. pLR w m ,.....l.x 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 '` • y Calculate difference: Actual Superheat - Target Superheat = System passes if difference is between -60F and +6oF ,. Enter Pass or Fail ' Reg: 212-A0005868A-M2500001A-M25A Registration Date/Time: 2012/02/06 20:43:58 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5) Site Address: Enforcement Agency: Permit Number: 49755 AVENIDA (Sys 2), La Quinta CA 92253 City of La Quinta 112-64 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 * J, $ 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 = t Tsuction - Tevaporator, sat Enter allowable superheat range from man ufacturer`s specifications (or use range between 3°F and 26°F if manufacturer's specification is not available) o- ... System passes ifactual'superheat is wdthin'the allowable superheat rangeEnter,Pass * J, $ �or Fair Reg: 212-A0005868A-M2500001A-M25A Registration Date/Time: 2012/02/06 20:43:58 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5) Site Address: Enforcement Agency: Permit Number: 49755 AVENIDA (Sys 2), La Quinta CA 92253 City of La Quinta 12-64 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): 278137. System meets all refrigerant charge and airflow E3 not-tested/verified dwelling in ' la • HERS sample group requirements. , 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: 1/4/2012 CC2004131 K AA f DECLARATION STATEMENT) . I certify under penalty of perjury, und&,the laws of the State of California, the information provided on this form is true and correct. I am the certified HERS raterwho performed the verification services identified and reported on this certificate (responsible rater). . The installed feature, material, component, or manufactured device requiring HERS verification that is identified on this certificate (the installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified on the Certificate(s) of Compliance (CF -111) approved by the local enforcement agency. ' The information reported on applicable sections of the Installation Certificate(s) (CF -611), signed and submitted by the person(s) ; responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -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): 278137. Q tested/verified dwelling E3 not-tested/verified dwelling in ' la • HERS sample group HERS Rater Information CalCERTS Certificate # CC1-1798627077 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: 1/4/2012 CC2004131 Reg: 212-A0005868A-M2500001A-M25A _Registration Date/Time: 2012/02/06 20:43:58 HERS Provider: CalCERTS,«Inc. 2008 Residential Compliance Forms March 2010 Enter the Duct System Name or Identification/Tag: System 1 ?, Enter the Duct System Location or Area Served: Kitchen Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the dwelling. t 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." t Duct Leakage Diagnostic Test - existing duct system Select one compliance method from the following four choices. ❑ 1. Measured leakage less than 15% of fan flow , ❑ 2. Measured leakage to outside less than 10% of Fan Flow 4 ! ® 3. Reduce leakage by 606io and conduct smoke and fix all leaks , ❑ 4. -Fix all._ accessible leaks using smoke and HERS rater verify F, M wa Note:•(One of Options 1, 2 or 3 must:.be attempted before utilizing Option 4.) . Determine nominakFan Flow using one of the following three calculation methods ns= < 4 x 400 1600 CFM t ✓ 0 Coolmgk yste method: Size of onden e m ToUZI � ✓ ❑Heating system method':, -r71.1'. 7 x +Output Capacity In Thousands of�Btu/hr • -••-• _CFM :. yir ✓ ❑Measured system3airflow using; R .3 3, airflow test;procetlures � `CFM Option .mused then 8- Allowed'leaka Fan Airs -flow0 1 er x Y Actual Leakage = - •CFM Pass if Actual Leakage is less than Allowed leakage Pass Fail Option 2 used then!:,--} 2 ' Allowedieakage Fan Airflow'" z 0.10 = _ CFM Actual Leakage to outsidefit•"' CFM Pass if Actual leakage to outside is less than Allowed leakage Pass r3 Fail' Option 3 used then::' ' Initial leakage prior to stait_of:work = 1069 CFM Final leakage after sealing all'accessible leaks using smoke test = 402 CFM 3 Initial leakage' 1069 - Final leakage 402 = Leakage reduction , 667 CFM ((Leakage reduction 667 / Initial leakage 1069 ) x 100% = 62.39 % Reduction Pass if % Reduction > 60%1 a Pass r3 Fail Option 4 used then: 4 All accessible leaks repaired using smoke test. HERS rater must verify (No Sampling). -- l' Pass if all accessible leaks have been repaired using smoke C3 Pass fail - •fir - Reg: 212-A0003869A-M2100001A-0000 Registration Date/Time: 2012/02/02 18:16:27 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms _ March 2010 ,r ! - •fir - Reg: 212-A0003869A-M2100001A-0000 Registration Date/Time: 2012/02/02 18:16:27 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms _ March 2010 INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS Duct Leakage Test - Existing Duct System (Page 2 of 21 Site Address: Enforcement Agency: Permit Number: 49755 AVENIDA, La Quinta CA 92253 (System 1) City of La Quinta 12-64 is 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 tb-the closed position during duct leakage testing. 0 All supply andsreturn register boots -mustibe,sealedAp,,the drywall-if$smoke testis utilized=for-compliance - applies to duct leakage compliance option -((leakage redu'etion by 60 /o) an optioh,4 (fix all accessible leaks) described above. E ® New auct'installation cit;utiliz( 10 Mastic Iding cavitlesa`s,plenums�platform returns ilieu of-ducts`�y leaks at all new duct connections DECLARATION STATEMENT • I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. • I am eligible under Division 3'of the Business and Professions Code to accept responsibility for construction, or an authorized representative of the person responsible for construction (responsible person). • I certify that the installed features materials, components, or manufactured devices identified on this certificate (the installation) conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the enforcement agency. • I understand that a HERS rater will check the installation to verify compliance, and that that if such checking identifies defects, I am required to take corrective action at my expense. I understand that Energy Commission and HERS provider representatives will also perform quality assurance checking of installations, including those approved as part of a sample group but not checked by a HERS rater, and if those installations fail to meet the requirements of such quality assurance checking, the required corrective action and additional checking/testing of other installations in that HERS sample group will be performed at my expense. • I reviewed a copy of the Certificate of Compliance (CF -1R) form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF -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 Danielle Garcia CSLB License: 686310 Date Signed: 11/26/2011 Position With Company (Title): Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? ❑ Yes ❑ No Reg: 212-A0003869A-M2100001A-0000 Registration Date/Time: 2012/02/02 18:16:27 HERS Provider: CalCERTS, 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: 49755 AVENIDA, La Quinta CA 92253 1 City of La Quinta 12-64 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 Kitchen 1 0Yes ❑ 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 0 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. h '' Enter Pass or Fail ✓ 0 Pass ✓ ❑ Fail STMS- Sensor on the Evaporator Coil' System 'Na me,or Identification/Tag!� ';: System 3'„ 71,;? � -4 '- 7 AT t ; j!" The sensor is factory installed, or field installed according to manufacturer's The sensor is facto installed; or field installed: aceordin to manufacturer s 3 ❑ Yes ❑.Noy 'specifications, or Winstelled, by methods/specifications approved by the Executive of Director: 4 ❑Yes I ; ❑ No The sensor wife is terminated with.a standard -mini plug suitable for con, nectiomto a digital thermometer The sensor, mini plug 57Aac(essible to the£ n tailing technician ❑ Yes R digital thermometer. The sensor mini plug is accessible to the installing technician and the'HERS;raterWthout`changin`g;the"airflow'through the cgndensercoil 5 ❑ Yes ❑ No 11The sensor measures the saturation temperature of the coil within 1.3 degrees F Yes to,3,-4; and 5 is^S` pass. Enter N/A if STMS are not 7 ✓ p N/A ✓ Pass ✓ Fail applicable: Otherwise enter Pass or Fail ✓ ❑Pass ✓ ❑Fail applicable. Otherwise enter Pass or 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 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 Fail Reg: 212-A0003869A-M2500001A-0000 Registration Date/Time: 2012/02/02 18:18:09 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-611-MECH725-HERS 4 Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5) Site Address: Enforcement Agency: Permit Number: 49755 AVENIDA, La Quinta CA 92253 City of La Quinta 12-64 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. s Space Conditioning Systems System Name or Identification/Tag System 1 � p System Location or Area Served Kitchen (must be re -calibrated monthly) ' Outdoor Unit Serial 5811M06064 Outdoor Unit Make Lennox Outdoor Unit Model XC21-048 Nominal Cooling Capacity Btu/hr r 49500 Date of Verification 1-26-11 F a. 1-1-12 � p t Calibration of -.:Diagnostic Instruments _ Date'of Refrigerant Gauge Calibration _ 1-1-12 (must be re -calibrated monthly) p Date of Thermocouple Calibration t �• (must be re -calibrated monthly) pY Supply, (eJaporeor leaving) air dry -bulbi temperature (TsupplY k5 � '4; Measured Tem eratures� °F' System Name or Identificayytion/Tag{{ System 1 , p $Wfj5 Supply, (eJaporeor leaving) air dry -bulbi temperature (TsupplY b) , Return (evaporator entering) air dry-bulb n 65 tempre eratu,{Treturn db) Return (evaporator entering) air wet, =bulb temperature '' S0 (Treturn, wb) ', a Evaporator saturation temperature, _ 36 (Tevaporator, sat) - Condensor saturation temperature~ 71 (Tcondensor, sat) - Suction line temperature (Tsuction) 53 » Liquid Line Temperature (Tliquid) 69 Condenser (entering) air dry-bulb 70 temperature (T condenser db), 'Reg: 212-A0003869A-M2500001A-0000 Registration Date/Time: 2012/02/02 18:18:09 HERS'Provider: Ca10ERTS, Inc. 2008.Residential Compliance Forms a August 2009 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 Name or Identification/Tag System i Calculate: Actual Superheat = Tsuaion - Tevaporator, sat k Calculate: Actual Temperature Split = Treturn, 19.00 ' Target Superheat from Table RA3.2-2 using db - Tsupply, db Treturn, wb and Tcondenser, db Target Temperature Split from Table RA3.2-3 18 Calculate difference: - using Treturn, wb and Treturn, db Actual Superheat = Target Superheat = Calculate difference: Actual Temperature Split System passes if difference is between -5°F and Target Temperature Split = +5°F Passes if difference is between -3°F and +3°F or, ' Enter Pass or Fail upon remeasurement, if between -3°F and PASS -100°F Enter Pass or Faill 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. VAR Calculated,Minimum Airflow Requirement (CFM) = Nominal Cooling Capacity (ton) X 300 (dm/ton) System'Namexorjdentification/Tag 1' ` Syst m 1 S; d`' I T . �. ".fir . f' ter ` Calculated Minimum Airflow Requirement (CFM) x ' R s Measured Air•flowfusing RA3 3 procedures (CFM) ' Passes if measured airflow is greaterthan'or, equal to the calculated minimum airflow requirement`s j + 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 T Y Calculate: Actual Superheat = Tsuaion - Tevaporator, sat k 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-A0003869A-M2500001A-0000 Registration Date/Time: 2012/02/02 18:18:09 HERS Provider: CalCERTS, Inc. t 2008 Residential Compliance.Forms . August 2009.. r ,. { r T Y Reg: 212-A0003869A-M2500001A-0000 Registration Date/Time: 2012/02/02 18:18:09 HERS Provider: CalCERTS, Inc. t 2008 Residential Compliance.Forms . August 2009.. r ,. { r Reg: 212-A0003869A-M2500001A-0000 Registration Date/Time: 2012/02/02 18:18:09 HERS Provider: CalCERTS, Inc. t 2008 Residential Compliance.Forms . August 2009.. r ,. { INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 53 Site Address: Enforcement Agency: Permit Number: 49755 AVENIDA, La Quinta CA 92253 City of La Quinta 12-64 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 = 2.0 Tcondenser, sat - Tliquid Target Subcooling specified by manufacturer 4 Calculate difference: -2 Actual Subcooling - Target Subcooling = System passes if difference is between -3°F and +3°F PASS r ,4.H. Enter Pass or Fail �l"; PASS-' 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 _ 17.0 Tsuction - Tevaporator, sat 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'bctuU superheat is with nAhe F r ,4.H. allowable superheat range �l"; PASS-' ,,:,Enter Pass or Fail_. r Reg: 212-A0003869A-M2500001A-0000 Registration Date/Time: 2012/02/02 18:18:09 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: 49755 AVENIDA, La Quinta CA 92253 City of La Quinta 12-64 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 1 CSLB License: 686310 Date Signed: 1/26/2011 Position With Company (Title): System meets all refrigerant charge and airflow Name of TPQCP (if applicable): Control Program (TPQCP)? ❑ Yes ❑ No requirements. PASS Enter Pass or Fail 1 I _M r . .. ,., .,.._.. �T ... n 4 I T I i i DECLARATION STATEMENT • I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. • I am eligible under Division 3 of ;the Business and Professions Code to accept responsibility for construction, or an authorized representative of the person responsible for construction (responsible person). • I certify that the installed features, materials, components, or manufactured devices identified on this certificate (the installation) conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the enforcement agency. • I understand that a HERS rater will check the installation to verify compliance, and that that if such checking identifies defects, I am required to take corrective action at my expense. I understand that Energy Commission and HERS provider representatives will also perform quality assurance checking of installations, including those approved as part of a sample group but not checked by a HERS rater, and if those installations fail to meet the requirements of such quality assurance checking, the required corrective action and additional checking/testing of other installations in that HERS sample group will be performed at my expense. • I reviewed a copy of the Certificate of Compliance (CF -1R) form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF -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 Danielle Garcia CSLB License: 686310 Date Signed: 1/26/2011 Position With Company (Title): Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? ❑ Yes ❑ No Reg: 212-A0003869A-M2500001A-0000 Registration Date/Time: 2012/02/02 18:18:09 HERS Provider: Ca10ERTS, 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: 49755 AVENIDA (sys 2), La Quints CA 92253 (System Enforcement Agency: Permit Number: 1) City of La Quinta 12-64 4 . 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, t use the Installation Certificate titled "Duct Leakage Test - Completely New or Replacement Duct System. " i. Duct Leakage Diagnostic Test - existing dud system ' Select one compliance method from the following four choices. ..: . ❑ 1. Measured leakage less than,15% of fan flow " ❑ 2. Measured leakage to outside.iltess than 10% of Fan Flow ; '1 FFF r j ® 3:.Reduce leakage by 60% and conduct smoke and fix all leaks ❑ 4:', Fix all acc se Bible leaks using smoke and HERS rater verify ' 1 ' •; . °(One Note: of 01?ti9ns 11 2 or 3 must be attempted,before utilizing„Option 4), . Determine nominal'Fan Flow using one of the following three”„calculation methods 4 � o -c <�A��,.x ✓€ 0 Cooling system method: Size of condenser in Tons 4 . x 400;= 1600 CFM , ki ,- ✓ `Output 13Heating.-systemmethod: 21 7X`-, Capack) Thousands of Btu/hr 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, t use the Installation Certificate titled "Duct Leakage Test - Completely New or Replacement Duct System. " i. Duct Leakage Diagnostic Test - existing dud system ' Select one compliance method from the following four choices. ..: . ❑ 1. Measured leakage less than,15% of fan flow " ❑ 2. Measured leakage to outside.iltess than 10% of Fan Flow ; '1 FFF r j ® 3:.Reduce leakage by 60% and conduct smoke and fix all leaks ❑ 4:', Fix all acc se Bible leaks using smoke and HERS rater verify ' 1 ' •; . °(One Note: of 01?ti9ns 11 2 or 3 must be attempted,before utilizing„Option 4), . Determine nominal'Fan Flow using one of the following three”„calculation methods 4 � o -c <�A��,.x ✓€ 0 Cooling system method: Size of condenser in Tons 4 . x 400;= 1600 CFM , ki ,- ✓ `Output 13Heating.-systemmethod: 21 7X`-, Capack) Thousands of Btu/hr ✓ ❑ Measured system airfl•owusing RAI,3-alrflow,,test procedures t -- (;FM•. 1 j0ption,l'used,then':Av� Allowed leakage Fan Airflow t x 0.15, _ CFM' • ,• = Actual Leakage— _ CFM Pass if Actual Leakage is less than Allowed leakage Pass Fail Option 2 used then:'F ..- ` y 2 Allowed leakage = Fan Airflow• '- x 0.10 = _ CFM Actual Leakage to outside,= ILZICFM Pass if Actual leakage to outside is less than Allowed leakage Pass Fail Option 3 used then: Initial leakage prior to start of work = 1154 CFM Final leakage after sealing all accessible leaks using smoke test = 410 CFM 3 Initial leakage 1154 - Final'leakage 410 = Leakage reduction 744 CFM ((Leakage reduction 744 / Initial leakage 1154 ) x 100% = 64.47 % 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: 212-A0005868A-M2100001A-0000 Registration Date/Time: 2012/02/02 18:20:00 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms t March 2010 INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS Duct Leakage Test - Existing Duct System (Page 2 of 2) Site Address: 49755 AVENIDA (Sys 2), La Quinta CA 92253 (System Enforcement Agency: Permit Number: 1) ,- City of La Quinta 12-64 i;- 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 configurecl. to the'closed position during duct leakage testing. r' 0 All supply and return registerboots',t be�sea ped to the drywall cif smoke test.i�s u�tilizedTfor compliance - appliestoduct leakage compliance option 3. (leakage reduction by.60%).and option 4 (fix allaccessible ,� leaks) described above Vyr. )fid I..' .. 0 New duct; installations cannot utllize6building cavities as plenums or',platfoC. rm returns in lieu of"ducts „ ... D Mastic and.draw bands°must be usedn combination with,cloth.backed�rubber,adhesive ducttape to seal leaks at all new duct connections" t. ,. '.�,,...u«,s,�"P,n�!'^� � � fx , .. , • .+ . .. . "u 1. 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). y • 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 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 Danielle 6urcia CSLB License: Date Signed: Position With Company (Title): 686310 1/26/2011 Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): l Control Program (TPQCP)? []Yes ❑ No ' Reg: 212-A0005868A-M2100001A-0000 Registration Date/Time: 2012/02/02 18:20:00 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms „i March 2010 . - 1 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) T 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. a' rv System Name or Identification/Tag System 2 - System Location or Area Se 3 ❑Yes paN'PV.Ispecifications, The sensor: is factory" instaIIed,,or�fiel&instailed; according,to,manufacturer's or isGstelle'd by methods%specifications approved by,Jhe Executive"" ❑ Yes t specifications, or is installed by methods/specifications approved by the Executive Director: `a 4 a: STMS', Sensor on -the EvaporatorXoil _ a System" IVame o�;:Identifcation/Tag ,, .Sy`stem 2 � F ;:q° , ;. 3 ❑Yes paN'PV.Ispecifications, The sensor: is factory" instaIIed,,or�fiel&instailed; according,to,manufacturer's or isGstelle'd by methods%specifications approved by,Jhe Executive"" ❑ Yes t specifications, or is installed by methods/specifications approved by the Executive Director: `a 4 / Q Yes .' ❑ No The sensor wire is terminated withstandard mini plug suitable for connection10 digital' thermometer The sensor,mmiz plug is accessibl ' to the i.n�stallingatechnician� f The sensor wire is terminated with a standard mini plug suitable for connection to a and the. HERS, rater without changing th'e airflow through the condenser coil 5 ❑ Yes - ;❑ No . The sensor measures the saturation temperature of the coil within 1.3 degrees F Yes'to,3;-4;.and 5 is Sxpass. Enter N/A if STMS are not ✓ ®N/A' ✓ ❑Pass ✓ ❑ Fail ' a pplicable.,Otherwise enter Pass ory Fail7 ❑ No - Yes to 6, 7, and 8 is a pass. Enter N/A if STMS are not T✓ 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. f 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 The 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 T✓ ®N/A ✓ ✓ [I Fail applicable. Otherwise enter, Pass or Fail ,❑Pass Reg: 212-A0005868A-M2500001A-0000 Registration-Date/Time: 2012/02/02,18:21:35 HERS Provider: CalCERTS, Inc. 2008,Residential Compliance Forms t ' :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: 49755 AVENIDA (Sys 2), La Quinta CA 92253 City of La Quinta 12-64 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 2 (must be re -calibrated monthly) System Location or Area Served Living i 1 12"'1,'iiE (mus b re calibrated. monthly) Outdoor Unit Serial # 1911KO4751 Outdoor Unit Make Lennox Outdoor Unit Model 14ACX-048 Nominal Cooling Capacity Btu/hr 49500 Date of VerificationF1-26-12 47 9-aimrailon'Or". NIa9nosilc i strumenis Date of Refrigerant Gauge Calibration 1-1-12 (must be re -calibrated monthly) Date of"The mocoupie Calibration i 1 12"'1,'iiE (mus b re calibrated. monthly) Supply (evaporator leavmg),air dry-bulb-_ 4Q." rianbuircu , ; , r•, s.. -,, fi:r `. fi'" " ":.'_ 1 'a.= 1. _ System Name or Identifcation/Tag System'2 Supply (evaporator leavmg),air dry-bulb-_ 4Q." temperature"(Tsupp Return (evaporator -entering) air dry-bulb 60 temperatu�e,(Treturn, db) Return (evaporator entering) air wet -bulb 47 temperature (Treturn wb) Evaporator saturation temperature -: 34 (Tevaporator, sat) Condensor saturation temperature 82 (Tcondensor, sat) Suction line temperature (Tsuction) 52 Liquid Line Temperature (Tliquid) 75 Condenser (entering) air dry-bulb 71 temperature (Tcondenser, db) Reg: 212-A0005868A-M2500001A-0000 Registration Date/Time: 2012/02/02 18:21:35 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION. CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5) Site Address: Enforcement Agency: Permit Number: _ 49755 AVENIDA (Sys 2), La Quinta CA 92253 City of La.Quinta 12-64 t; 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 Name or Identification/Tag System 2 Calculate: Actual Superheat = Calculate: Actual Temperature Split = Treturn, 20.00 - db - Tsupply, db Target Superheat from Table RA3.2-2 using Target Temperature Split from Table RA3.2-3 �/ 17 Treturn, wb and Tcondenser, db using Treturn, wb and Treturn, db Calculate difference: Calculate difference: Actual Temperature Split - 3 Actual Superheat -_Target Superheat = Target Temperature Split = . . System passes if difference is between -5°F and Passes if difference is between -3°F and +3°F or, +5°F upon remeasurement, if between-30F.and PASS Enter Pass or Fail -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 soecified 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 quiment ( ) Cooling Ca = g aci p ty (ton) X 300 (cfm/ton) ; _ • ¢ u,. System Na�me o Id ntification/Tag� stem yS Calculated Minimum Airflow,Requirement (CFM) # rk -� Measured,Aiifiow,,using RA3.3 procedures Passes if measured' airflow, is greater'. or. M; ° equal to the calculated minimum airflow` requirement . s"r`.7'-5 Enter;Pass or Fail Superheat Charge MethodCalculations 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 = 41 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 f � +3 f . s �a •r - . - Reg: 212-A0005868A-M2500001A-0000 Registration Date/Time: 2012/02/02,18:21:35 HERS Provider: CalCERTS, Inc. a 2008 Residential Compliance Forms + '.August 2009 41 •r - . - Reg: 212-A0005868A-M2500001A-0000 Registration Date/Time: 2012/02/02,18:21:35 HERS Provider: CalCERTS, Inc. a 2008 Residential Compliance Forms + '.August 2009 INSTALLATION CERTIFICATE CF-611-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5) Site Address: Enforcement Agency: Permit Number: 49755 AVENIDA (Sys 2), La Quinta CA 92253 City of La Quinta 12-64 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 = 7.0 Tcondenser, sat - Tliquid Target Subcooling specified by manufacturer 8 Calculate difference: -1 Actual Subcooling - Target Subcooling = System passes if difference is between -3°F and +3°F PASS Enter Pass or Fail PASS 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 __ 18.0 Tsuction - Tevaporator, sat Enter allowable superheat range from manufaci&&'s'specifications (or use range 25 between 4°F and 25°F if manufacturer's specification is not available) ' ;> System passes if1actual"superheat iswithmMthe allowable superheat range PASS a,Enter Pass or.Fail A Reg: 212-A0005868A-M2500001A-0000 Registration Date/Time: 2012/02/02 18:21:35 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: 49755 AVENIDA (Sys 2), La Quinta CA 92253 1 City of La Quinta 12-64 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 1/26/2012 Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): requirements. PASS Enter Pass or Fail i ,l '-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). • 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 -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 buildings. 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: Date Signed: Position With Company (Title): 686310 1/26/2012 Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? ❑ Yes ❑ No Reg: 212-A0005868A-M2500001A-0000 Registration Date/Time: 2012/02/02 18:21:35 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms August 2009 HVAC Field Data Sheet Pg 1 oft Client Name Job # I ' 037 Date Address H S 73 > r4t, exWr'O Ph #67 66-) Technicians) ��w--Permit # Gauge/Thermocouple Calibration Date f / - / Z _ llt�t Package ( Some Ducts Only 1 All Ducts Only (Circle type of work) Amp?—" EgufpmentDaOu ZONE I ZONEZ ZONE 1 ZONE4 System Location or Area Served Heating Equipment Make Heating Equipment Model � , cc ARI Reference NumberJJeatia �p SQ'=,.'�...f.:!'b6-V,G G Dud Location (attic, crawlspace, etc.) Scy r-, T Duct R -Value (if ducts were inst3Hed) Heating Load Heating Equipment Output Capadty Condenser Make EM °ba -70, $100 L•�-X L �v Condenser Model Size in Tons SEER & EER j y wc ,t _ &,.1 1 Cooling Load Cooling Capacity WOK" & 21 pact restfirg y r, Svv Dud Ieakage pretest result Dud Leakage Final Result QACFM/taa to Pass (6%) Duct Leakage FinalResult 40cm/ton topass CIS%) ,ty �tlJ acid/+ PawIF" P=IPA PassIM Paalm PasslFae PassIFA YO Z y ( O pasoFa PaSOFA Pass using 60% leakage reduction? Pass using smoke and visual inspection? M2,2.' orM.OalZS 'CoolfVCoflAirjlow& Pan.#fY ,Vraw . Measured Air Volume from Flow Grid or Hood NEW DUCTS Target; 350 CFM/ton x Condenser Tons CU MGEOUT Target 300 CFM/ton x condenser Tons Measured air greater titan Target? (YIN) Measured Fan Watt Draw Target 058 watts/measured CFM = Measured Watts less than Target? (YIN) copyright a 2011 EDS EaeU Drtvea soluoton; hm HVAC Field Data Sheet Pg 2 of 2 Client Name K )e6 7 job #- 12-9o3-7 Date ` Z c_-' z MrGff-ZS Qtmge AAirflow ZONE 1 ZONE Z ZONE 3 ZONE 4 Condenser Serial Number 5W I W 0C 0 6 ti f i r (Ko N'7.T/ Supply air dry bulb temperature 1/6; Ko Return air dry bulb temperature 60 Return air wet bulb temperature sv 4(-7 Evaporator Saturation Temperature 3 3'-/ Condenser Saturation Temperature 7/ Suction Line Temperature S�3 1-2 Liquid Line Temperature ;PS - Suction Pressure Liquid Pressure Actual Airflow Temperature Split ! �' Target Temperature Split from Table RA3.2.3 18 / 5 Passes if difference is t 3° of Target Temp (YIN) Y X Actual Subcooling (t 4° of Target tu pass) 3 7 Target Subcooling from Mfr. Actual Superheat (3 to 26" to pass) 4-( 17 g Outside air dry bulb temperature WCKZ6-W h-1ttOwVingbelow55" 7 v 7 / Actual Line Set length (ft) Mfrs Standard Line Set Length (ft) Length Dii%rence = Correction Factor (ounces per foot) Target Correction Factor x Length Difference System Charged to Target? (Y/N) Other Data Minimum amps Maximum amps 2 "r - ;1- 5 � Breaker size ti'v 5'0 Compressoramps Return Static Pressure ef, Supply Static Pressure Supply Air Wet Bulb Temperature • • ALL APPLICABLEBOX W ON TMSFORHMUST BECOMPLETED FOR Mff JOR NO EXCEPTION . • Copyr% t 0 2011 MS EneW Ddm Sola OM lac SMOKE AND CARBON NION.OXIDE ALARM RETROFIT VERIFICATION I, FCi rzb .X , and I, (Print Property Owner's Name) (Tenant's Name - if same as Owner write "same") who own and/or live in the dwelling located at: 11 7 y S 7-. (Address) . verify that the smoke and carbon monoxide alarms required by the California Residential Code (CRC) have _..._._.. _.._ _ _ _ -! mi ► .1 la-the-dwelling,-ir- ompli ,s �1th tF caGe and iii e ria nufastu�rer's instruct or,- � ;d #urt ; �r-__.•.._ .that hey have -been -tested and do function properly:..,._ ..-... .... ,.r_M .._..:.: _....� In an effort to enhance life safety within dwellings, CRC Section R314.6, R316.2 and CBC 420.4 require the retrofit of these alarms in existing dwellings when alterations, repairs or additions requiring a permit and exceeding $1,000 in value are made. Generally, the alarms must be hard wired (110 volt) with battery back-up and all alarms are to be interconnected. If the installation of the alarms will require the removal'of wall or ceiling finishes or there is no access by means of attic, basement or crawl space, then alarms may be solely battery operated and not interconnected. Alarms must be installed in all of the following -locations within the existing dwelling: ➢ In all bedrooms (only require Smoke Alarms) ➢ Immediately outside of,each separate bedroom. (require Smoke and Carbon Monoxide Alarms) ➢ In each story level of the dwelling, including basements and habitable' attic rooms (require Smoke and Carbon Monoxide Alarms) These safety devices must be installed by the time a final inspection is requested for your project. I understand the above requirements and certify that we now have smoke alarms and carbon monoxide alarms installed, that comply. We agree to comply with the CRC. in regards to. smoke alarms, carbon monoxide alarms. Signature of wner. Ute -Signature of Tenant Date ATTENTION OWNER - OCCUPANT: This is a Voluntary Smoke and Carbon Monoxide Alarm verification procedure.. /f you prefer a Building Inspector to perform the verification, you must arrange to have an adult present at the time of inspection. NOTE: This Verification is only used when normal access to the interior of the dwelling by the City of: uilding Inspector is not achieved during the course of project construction. It is normally used for projects such as re-rooring, re -siding, patio covers, swimming pools and the Tike. .y . 4t\ P.O.kBOX 1504 Building 78-495 CAI LE TAMPICO Address 49"755 Ave. Montero LA QUINTA, CALIFORNIA 92253 t. Braun Mailing Address Same City Zip Tel. La Quinta, CA 192253 Contractor :Ruben Vasruez Roof ina 45-020 Arun St. Cjty Zip Tel.: ��fdio, CA 52201 347--5683 State Lica City & Classif. , C-39450498 Lic. # 1157 Arch.,•Engr.; Designer Address Tel. City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION r I I hereby affirm that I am licensed under pt'o"visions of Chapter 9 (commencing with Section 7000) of Division 3 of the Bus, �nge,��e' and Rrbfessions Code, and my license its in full force d r�%1R; 7Z r -z SIGNATURE ! s�3 DATE LD OWNER•BUIER DEC[ TION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a permit to construct, atter, improve, demolish, or repair any structure, prior to Its issuance also requires the applicant for such permit to file a signed statement that he is licensed pursuant to t the provisions of theContractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or that. he 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). ❑ 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, Buisness and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon and who does such work "himself or through his own employees, provided that such 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. dM not build or knprove for the purpose of sale.) ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractors) P.censed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No.,/ Company I Copy is filed with the city. O Certified copy is hereby furnished.. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation 'or less.) I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. • Date �_Owner N0. 15865 11LDING: TYPE CONST. OCC: GRP. P. Number gal Description oject Description Rer0OIL' Sq. Ft. No. No. Dw Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation $4.r30fl.0Q, ZONE: PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Rear Setback from Rear Line Const. 30.00 Mech. SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO' ONE Electrical / Plumbing S.M.I. DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND Grading en Driveway Enc. 1 . FINAL DATE Infrastructure This is a building permit when properly filled out, signed and validated, and is subject to expiration it work thereunder is suspended for 180 days. I certify that I have read this application and state that the above information. is correct. Issued by: Date Permit I agreeto comply with all city and county ordinances and state laws relating to building construction, and hereby this TOTAL 30 AQ REMARKS NOTICE TO APPLICANT: N, after making this Certificate of Exemption you. should become ZONE: BY: ' subject to the Workers' Compensation provisions of the Labor, Code, you must forthwith comply with such proviskms.or this permit shall be deemed revoked. Minimum Setback Distances: Front Setback from Cente1�l iR Rear Setback from Rear Line WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL', AND Side Street Setback tr enter SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO' ONE - / HUNDRED THOUSAND DOLLARS ($100,1))0), IN ADDITION TO THE COST OF. COMPENSATION, Side Setback from P pertvAine ' DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND en ATTORNEY'S FEES. FINAL DATE T IN aECTQ R This is a building permit when properly filled out, signed and validated, and is subject to expiration it work thereunder is suspended for 180 days. I certify that I have read this application and state that the above information. is correct. Issued by: Date Permit I agreeto comply with all city and county ordinances and state laws relating to building construction, and hereby this authorize representatives -of city to enter the . above-. mentioned property for inspection purposes. r Validated by: Signature of applicant Date Mailing Address - - .Validation:. _ City, State, Zip CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBIW FEES 1ST FL. SO. FT. ® $ 2ND FL. SO. FT. POP.. SO. FT. GAR. SO. FT. ® CAR P. SO. FT. WALL - SO. FT. SO. FT. ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN. URINAL WATER PIPING NOTE: Not to be used as property tax valuation BONDING FLOOR DRAIN MECHANICAL FEES FORMS WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APP./EOUIP. LAUNDRYTRAY AIR HANDLING UNIT CFM TEMP. POLE KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET COMPRESSOR HP POLE, TEM/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. ® c BATH TUB SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/e c SEWAGE DISPOSAL SO.FT.GAR ® 3/ac HOUSE SEWER REMARKS: GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MEC FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP./EOUIP. P.EINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING. CU. yd. lusx$ $ —plus—x$— , _$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. P,-jrROOFING �j% REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL w RUBEN M. VASQUEZ ROOFING 45-020 ELM STREET (619) 347-5683 INDIO. CA 92201 UC. NO. 456498 Dais: OCT. 10 I9—L5–. TO TOM KENNEDY DRAUN' RFSTDFNNCF. 49-755 MO N T E R 0 ESTATES L. Q. (hereinafter • •Owner"), Telephone no. ( ) RUBEN •INi VASQUEZ ROOFING (hereinafter "Contractor") proposes) -to furnish all materials and perform all labor necessary to complete.the following: [Insert a description of the work'to be done and a description of the materials to be used and the equipment to be used or installed, and state the address of the job site.) 1. REMOVE OLD ROOFING COMPLETELY AND REPLACE ANY DAMAGED PLYWOOD. PLYWOOD WILL BE BILLED EXTRA AT THE.RATE OF $25.00 PER SHEET. 2. REROOF USING THE FOLLOWING: ONE PLY 28# GLASS BASE 14AILED ON T1?U PLL ilii GLASS PLY MOPPED BETWEEN LAYERS WITH 254 HOT ASPHALT PER MOPPING 60# FLOOD COAT AND 400#.WHITE ROCK PER SQ. I SCALL CANT STRIP AT BASE OF ALL WALLS AND MOP ON ONE LAYER OF 72ii GLASS CAP. INSTALL ALL NEW PETAL EDGING. 3. CLEAN ALL ROOF DEBRIS UPON COMPLETION.. 4.'GUARA,;TER ROOF LABOR AND MATERIAL FOR FIVE YEARS FROM DATE OF COMPLETION. 5. OBTAIN REQUIRED PERMITS. All of the above work is to be completed in a substantial and workmanlike manner according to standard practices for the sum of. FOUR THOUSAND THREE HU -1T RED Dollars IS 4300.00 ). Progress payments shall be made as follows: PAYMENT ' Ii: FULL UPON COMPLETION to the value of ONE HUNDRED per cent ( 100 %) of all work completed. The remaining balance of the contract is to be paid wW UPON 'Ayl r completion. This proposal -is valid until XXXXXXXXXXXIXXnd if accepted on or before that dale, work will commence approximately on XXXXXXXXX and will be substantially completed approximately on XXXXXXXXXXXXXXXXXXXX subject to delays caused by acts of God, stormy weather. uncontrollable tabor trouble, or unforeseen contingencies. Any alteration or deviation from the above specifications, including but not limited to any such alteration or deviation involving additional material and/or labor costs, will be executed only.upon a written order for same, signed by Owner and Contractor, and if there is any charge for such alteration or deviation, the additional charge will be added to the contract price of this contract. It any payment is not made when due, Contractor may suspend work on the job until such time as all payments due have been made. A failure to make payment for a period in excess of 5 days from the due date shall be deemed.a material breach of this contract. Respectfully submitted. Name and Registration No. of any Salesperson who solicited or negotiated this contract: Name: No. RUBEN M. VASQUEZ Nemo of eanrictor By si"W 45-020 ELM ST - Street Address INDIO, CA. 92201 ( 3)4_7_5683 CRY Syts zo Telephone No 456498 _ comam's state LAW" No ACCEPTANCE You are hereby authorized to furnish all materials and labor required to -complete the work mentioned in this Proposal, for which I/we agree to pay the contract price mentioned in this Proposal, and according to the terms thereof. I/we have read and agree to the provisions contained herein, and in any attachments hereto, which are made a part hereof and are described as .Or+ner's None Street Address city State . Zip l I BYS.neSS Address Business Phone No ACCEPTED: lowner'sS-geaturet (Wtet Contractors,are required by law to be licensed and regulated by the Contractors' State Ucense Board. Any questions concerning a contractor maybe referred to the Registrar, Contractors' State Ucense Board, P.O. Box 26000, Sacramento, CA 95626 Qum& P.O. BOX 1504 Building- 4 3--755 Avenida Montero 78-495 CALLE TAMPICO Address I LA QUINTA, CALIFORNIA 92253 ...,, , Bila Braun Mailing Address Same,as above City La�uinta Fp 92253 Tel. 5614-4277 Contractor TA Kennedy Construction I 77350 Arroba CityZip Tel.: .1a Qui.nta. 92253 564-4660 State Lic. City & Classif. ; 442118 Lic. # •469 Arch., Engr., Designer XUA Address Tel, 12242 Bus Park tip. (916) 537.46257 City Zip State Truckee 96161 Lic. # C-17210 LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter g (commencing with Section 7000) of Division 3 -of the Business and -Professions Code, ,and my license is in full force and e fect. �. f x•__� wf� SIGNATURE -il `Xl I's DATE '. OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also requires theapplicant for such permit to the a signed statement that he is licensed pursuant to the prodslons of he Contractor's License Law, Chapter 9 (commencing with Section 7000) or Division 3 of the Business and Professions Code, or that. he Is exempt therefrom, and the basis forthe 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). O 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, Buisness and Professions Code: The Contractor's. License Law does not apply to an owner or property who builds or Improves thereon and who does such work himself or through his own employees. provided that such 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 or proving that he did not build or improve for the purpose of sale.) ❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractors) Pcensed pursuant to the Contractor's License Law.) .r ❑ 1 am exempt under Sec. - B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's Comp€osation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No."-, .Company O[Copy.is filed with the city, ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed B the permit is for one hundred dollars ($100) valuation or less.) I certify that in the performance of the work for which this permit is issued, I.shall not employ any peon in any manner so as to become subject to the Workers' Compensation Laws of. Californirsa Date Owner NOTICE TO APPLICANT: if, alter making this Certificate of Exemption you should become. subject to the Workers' Compensation provisions of the • Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. • WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF. THE LABOR CODE; INTEREST, AND ATTORNEY'S FEES. This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. 1 certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city .to enter the above.. mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip No. 15743. NG: TYPE CONST. OCC: GRP. P. Number .gal Description oject Description . Ad'di.t: on& Remodel Sq. Ft. 99:sf' Size New ❑ Ad No. Stories No. Dw. Units Alter ❑ Repair ❑ Demolition ❑ 5timatedValuation. $40,000.00 PERMIT AMOUNT Plan CWDep. Plan Chk: Bal. • Const. « Mech. 15a J Electrical 3 Plumbing . CP S.M.I. 4... U Grading Driveway Enc. Infrastructure TOTAL' 6 REMARKS ' ZONE: BY: Minimum Setback Distances: Front Setback from Center e Rear Setback from Rear P i Side Street Setback fr, nter Li Side Setback. frorr ropertA.Lin FINAL DATE -Issued by: Date_ Validated by: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBIW',"EES 1ST FL. SQ. FT. ® $ 2ND FL. SO. FT. ® POR. SO. FT. ® GAa. SO. FT. ® CARP. SQ. FT. WALL SO. FT. SO. FT. ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM ' BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN. URINAL WATER PIPING NOTE: Not to be used as property tax valuation BONDING FLOOR DRAIN MECHANICAL FEES FORMS WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APPJEOUIP. LAUNDRY TRAY AIR HANDLING UNIT CFM TEMP. POLE KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET' COMPRESSOR HP POLE, TEM/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. ® c BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/e c SEWAGE DISPOSAL ,'-14 awe /—j (i(//�f0 SO.FT.GAR ® 3/ac HOUSE SEWER REMARKS: GAS PIPING PERMIT FEE MIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE EPL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR.COND. SOLAR SETBACK GROUND PLU UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCKSTORAGE FOUND. REINF. 0+" GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEOUIP. REINF. STEEL % GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ =$ LUMBER GR. FINAL INSP.. FRAMING O FINAL INSP. ROOFINGQ ,'-14 awe /—j (i(//�f0 // 7 V _!nT// REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND /� 9 FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL 78-495 CALLE TAMPICO LA -GIUINTA, CALIFORNIA 92253 - (760) 777-7000 FAX (760),777-7101 TDD (760) 777-1227 December 23, 1997 Bill Braun 49-755 Avenida Montero La Quinta, CA., 92253 RE: Building Permit #15743 Dear Mr. Braun The purpose of this letter is to inform you that your Building Permit #15743, for the project at 49-755 Avenida Montero, has expired. In accordance with 1994 UBC section 106.4.4, no further work may be performed until a new permit has been'issued. Please contact Daniel P. Crawford Jr., Building Inspector I, at (760) 777-7.012 to obtain any information you need regarding a new permit and/or any required inspections. Should you choose not to complete the project, we would then have to pursue any or all of the following actions: 1) Abatement of the project through the City Attorney's Office and Code Compliance Division. 2) Notice of non-conforming structure placed upon property profile. -3.) Action filed with Contractor. State License Board. Optional if Owner/Builder: . Please contact us at your earliest convenience prior to 10 working days to resolve this issue, and for any questions you may have. Sincerely, Mark.Harold Buildin Safety Manager Daniel P. Crawford Jr. Building Inspector I cc: file dpc i MAILING ADDRESS - P.O. BOX 1504 - LA OUINTA, CALIFORNIA 92253 (J+;