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10-0404 (MECH)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: t10-00000404^_) Property Address: 7-9451—HORIZON PALMS CIR APN: 604-100-026-26 -19903 - Application description: MECHANICAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 6157 Applicant: T y Architect or Engineer: BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: OLSON CHARLES 79451 HORIZON LA QUINTA, CA ( PALMS CIRCLE 92253 -Contractor: DCS HEATING/AIR 72078 CORPORATE THOUSAND PALMS, (760)343-5566 Lic. No.: 595145 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 5/07/10 LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION .I hereby affirm under penalty of perjury -that I I'censed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations: Section 7000 of Division 3 oft usi ss nd ofessio als 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 License C ss C20 All I I License No.: 595145 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is n issued. Date: 11i I Contractor: '. 1 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 OWNER -BUILDER 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 HARTFORD INS Policy Number 72WECLS7131 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 mann so s to beco ubject to 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 shout ecome u j ct to the orkers' 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 d I h comp) with those provisions. that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by —'1 � t / D 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 Date: Applic'aht:�-, — ` , r__ ) • the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The WARNING: FAILURE TO SECURE WORKERS' COMPENSATION 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 1$100,0001. 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.). g APPLICANT ACKNOWLEDGEMENT (_ 1 I, 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 a 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, (_ 1 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 Date: Owner: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: _ Lender's Address: LQPERMIT e of La Quinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. ' I certify that I have read this application and state t he above ' for tion is correct. I agree to comply with all city and c nt ordinances and state laws relating obi ing co strut on, and ereby authorize representatives of this c ty o enter upon the above-mentionedop f r ' pe i urp ��441LI .p11 Date: Signature (Applicant or Agent): / - -''" Application Number . . . . . 10-00000404 Permit . . . MECHANICAL Additional desc . Permit Fee . . . . 33.00 Plan Check Fee 8.25 Issue Date . . . . Valuation . . . . 0 Expiration Date 11/03/10 Qty Unit Charge Per Extension BASE FEE 15.00 1.00, 9.0000 EA MECH FURNACE <=100K 9.00 1.00 9.0000 EA MECH B/C <=3HP/100K BTU 9.00 ---------------------------------------------------------------------------- Special Notes and Comments REPLACEMENT' OF -3 TON HEAT -'PUMP SPLIT .— _.._ _-___— . _.... _.. _ . _- ............. _........,._...... _... SYSTEM . 14 SEER R410A HEAT PUMP COMPLETE SYSTEM. ---------------------------------------------------------------------------- Other'Fees_ . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged Paid Credited ----------------- Due ---------------------------------------- Permit Fee Total 33.00 .00 .00 33.00 Plan Check Total 8.25 .00 .00 8.25 Other Fee Total 1.00 .00 .00 1.00 Grand Total 42.25 .00 .00 42.25 LQPERMTT Simplified Prescriptive Certificate of Compliance: 2008 Residential HVACAlterations CF -IR -ALT -HVAC Climate Zones 10 to 15 9 Site Address: _ , r � I � , n (� - Enforcement Agency: Date- Permit #: �n �jConditioned 12bib Floor EquipmentE ui ment Type' List Minimum Efficienc Z Duct insulation requirement Area Thermostat ❑ Packaged Unit ❑ Furnace ❑ AFUE 13COP Over 40 ft of ducts added or replaced in unconditioned space Served by system Setback door Coil ❑ SEER 11HSPF _ ❑ R 6 (CZ 10-13) M /f not already be ondensing Unit 11 EER ❑Resistance � L sf present, must 11 Other ❑ R 8 (CZ 14-15) installed) 1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -1 R -ALT -HVAC for each system. 2. Minimum Equipment Efficiencies: 13 SEER, 78% AFUE, 7.7HSPFfor typical residential systems. HERS VERIFICATION SUMMARY Listed below are four HVAC alteration Options. The installer decides what work is being done and picks one of the appropriate Options. Each Option lists the HERS measures that must be conducted. A copy of the forms shall be left on site for final inspection and a copy given to the homeowner. At final, the 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 sig Beginning October 1, 2010, a registered copy of the CF -111 and CF -6R shall also be on site for final inspection. I. HVAC Changeout Required Forms: • All HVAC Equipment replaced CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH- 25 -HERS CF -4R forms: MECH- 21 and (fors lits stems) MECH-25 • Condenser Coil and/or CF -6R forms: MECH-2I-HERS and (for split systems) MECH- 25 -HERS • Indoor Coil and/or CF -4R forms: MECH- 21 and (for split systems) MECH-25 • Furnace 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: ❑ 1. Duct system was documented to have been previously sealed and confirmed through HERS verification, or ❑ 2. Duct systems with less than 40 linear feet in unconditioned space, or ❑ 3. Existing ducts stems are constructed, insulated or sealed with asbestos ❑ 2. New HVAC System Required Forms: • Cut in or Changeout with new ducts: (all new ducting and all CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS 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 linear feet of duct in unconditioned space. CF -6R forms: MECH-04, MECH-2I-HERS CF -4R forms: MECH-21 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) • 1 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 1 and 6 of the California Code of Regulations. • The design features identified on this Certificate of Compliance are consistent with the i o tion ocu nted on ther applicable compliance forms, worksheets, ca lations, ns an specifications submitted to the enforcement agency fora royal wi a it licatio Name: Signature Company: Date: 1.261 \ 3 r Address n^ 1 �-#)DLicense City/State/Zip. ( Phone: 6— 343 ~s &� 2008 Residential Compliance Forms March 2010 Bin # Of La Quints Building &r 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:5 Y g Owner's Name: A. P. Number: Address: Legal Description: City, ST, Zip- Contractor: Telephone &� « :>`•><'•! Address: Project Description: City, ST, Zip—NIM I1,M aY l (il �� 1 ele h ne• TP0 'S Wp Nay JP state Lic. # : %c City Lie. #; O' Arch., Engr., Designer: Address: City., ST, Zip: Telephone: Construction Type: n./' P Y• Y Occupancy: State Lie. #: Project type (circle one): New Add'n Alter' epair Demo Name of Contact Person8 w Sq. Ft.: I # Stories: # Units: Telephone # of Contact Person: � Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2" Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- '"' Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees l INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS Duct Leakage Test - Existing Duct System (Page 1 of 2) Site Address: 79451 HORIZON PALMS CIRCLE, La Quinta CA 92253 Enforcement Agency: Permit Number: (System 1) City of La Quinta 10-404 Enter the Duct System Name or Identification/Tag: System 1 Enter the Duct System Location or Area Served: Whole House Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the dwelling. This installation certificate is required for compliance for alterations and additions in existing dwellings to space conditioning systems and duct systems. Note: For existing dwellings, a completely new or replacement duct system can also include existing parts of the original duct system (e.g., register boots, air handler, coil, plenums, etc.) if those parts are accessible and they can be sealed. For a completely new or replacement duct system installed in an existing dwelling, use the Installation Certificate titled "Duct Leakage Test - Completely New or Replacement Duct System. " Duct Leakage Diagnostic Test - existing duct system Select one compliance method from the following four choices. 1. Measured leakage less than,15% of fan flow 2. Measured leakage to outside less than 10% of Fan Flow 3. Reduce leakage by,60% and conduct smoke and fix all leaks 4: Fix all accessible leaks using smoke and HERS rater verify Note: (One of Options 1, 2 or 3 must be attempted befo_ re utilizing,Option4.)_ Determine nominal Fan Flow using one of/the following three calculation methods./,/ ✓ ✓ Cooling system method: Size of condenser in Tons 13 x 400 =1 1206 CFM ✓ x ' Heating system method: 21.7 _ Output Capacity in Thousands of Bt%hr = _ CFM 11�� procedures: / ✓ Measured -system airflow using RA3.3 airflow est CFM.t Option 1 used then: - - 1 Allowed leakage = Fan Airflow 1200 x 0.15 = 180 CFM Actual Leakage = _7 CFM Pass if Actual Leakage is less than Allowed leakage Pass Fail Option 2 used then: 2 Allowed leakage = Fan Airflow _ x 0.10 = _ CFM Actual Leakage to outside = _ CFM Pass if Actual leakage to outside is less than Allowed leakage Pass Fail Option 3 used then: Initial leakage prior to start of work = _ CFM Final leakage after sealing all accessible leaks using smoke test = _ CFM 3 Initial leakage _ - Final leakage _ = Leakage reduction CFM ((Leakage reduction _/ Initial leakage ) x 100% _ % Reduction Pass if % Reduction > 60% Pass Fail Option 4 used then: 4 All accessible leaks repaired using smoke test. HERS rater must verify (No Sampling). Pass if all accessible leaks have been repaired using smoke Pass Fail i Reg: 211-A0060018A-M2100001A-0000 Registration Date/Time: 2012/01/12 15:02:38 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS Duct Leakage Test - Existing Duct System (Page 2 of 2) Site Address: 79451 HORIZON PALMS CIRCLE, La Quinta CA 92253 Enforcement Agency: Permit Number: (System 1) City of La Quinta 10-404 4 Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off du`ring-duct leakage testing. CFI OA ducts that utilize controlled motorized dampers, that open only when OA ventilation is required to meet ASHRAE Standard 62.2, and close when OA ventilation is not required, may be configured to the closed position during duct leakage testing. V All supply and return register'hoots-must be sealed to the drywall if smoke test is utilized for. compliance - applies'to duct leakage compliance option 3 +(leakage reduction by 60%) and option'41#ix all'accessible leaks) described above!\C New duct installatiionns,cannot'utilize building cavities aslplenumslor platform returns In lieu of ducts. Mastic and draw bands must be used in combination with cloth backed rubber adhesive duct'tape to seal'-- leaks eal'-leaks at all new duct connections l DECLARATION STATEMENT • I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. . I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized representative of the person responsible for construction (responsible person). • I certify that the installed features, materials, components, or manufactured devices identified on this certificate (the installation) conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the enforcement agency. • I understand that a HERS rater will check the installation to verify compliance, and that that if such checking identifies defects, I am required to take corrective action at my expense. I understand that Energy Commission and HERS provider representatives will also perform quality assurance checking of installations, including those approved as part of a sample group but not checked by a HERS rater, and if those installations fail to meet the requirements of such quality assurance checking, the required corrective action and additional checking/testing of other installations in that HERS sample group will be performed at my expense. • I reviewed a copy of the Certificate of Compliance (CF -111) form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF -1R that apply to the installation have been met. • I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. I will ensure that all Installation Certificates will come from a HERS provider data registry for multiple orientation alternatives, and beginning October 1, 2010, for all low-rise residential buildings. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) D C S HEATING & AIR CONDITIONING INC Responsible Person's Name: Responsible Person's Signature: Chris Brown Chris Brown CSLB License: Date Signed: 111/3/2011 Position With Company (Title): 595145 Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? Yes No Reg: 211-A0060018A-M2100001A-0000 Registration Date/Time: 2012/01/12 15:02:38 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: 79451 HORIZON PALMS CIRCLE, La Quinta CA 92253 City of La Quinta 10-404 Note: If installation of a Charge Indicator Display (CID) is utilized as an alternative to refrigerant charge verification for compliance, a MECH-24 Certificate (instead of this MECH-25 Certificate) should be used to demonstrate compliance with the refrigerant charge verification requirement. TMAH and STMS are not required for compliance, when a CID is utilized for compliance. As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional form(s) for any additional systems in the dwelling as applicable. Temperature Measurement Access Holes (TMAH) and. Saturation Temperature Measurement Sensors (STMS) Procedures for installing TMAH are specified in Reference Residential Appendix RA3.2. If refrigerant charge verification is required for compliance, TMAH are also required for compliance. STMS are only required for completely new or replacement space -conditioning systems that utilize prescriptive compliance method. TMAH - Access Holes in Supply and Return Plenums of Air Handler System Name or Identification/Tag System 1 System Location or Area Served Whole House 1 ✓ Yes No j 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 f 5/16 inch (8 mm) access hole downstream of evaporative coil in the supply plenum and labeled according to Figure in Section RA3.2.2.2.2. Yes, to -1 and 2 is a pass. Enter Pass or Fail ✓ ✓ Pass ✓ Fail STMS - Sensor onythe Evaporator Coil System Nameor Identification/Tag j I ,el/-' I System i 1, j 7 7 ( ' � ° 7 r 5 3 Yes. No The sensor is factory installed, or field installed according to manufacturer's specifications, or is4installed by methoQspecifications approved by the Executive"" `, Yes No Director. I ,' i f 1�--� 4 Yes No The sensor wire is terminated with a standard mini plug suitable for connection to a, digital The is i thermometer. sensor mini plug accessible to the installing,tecKniaanire! gacable. Yes No and the HERS rater without changing the airflow through the condenser coil �` r 5 Yes No IThe sensor measures the saturation temperature of the coil within 1.3 degrees F Yes to 3, 4, and 5 is a pass. Enter N/A if STMS are not ✓ N/A ✓ Pass ✓ Fail applicable. Otherwise enter Pass or Fail ✓ ✓ N/A ✓ Pass ✓ Fail STMS - Sensor on the Condenser Coil System Name or Identification/Tag I System 1 The sensor is factory installed, or field installed according to manufacturer's 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 gacable. 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 Yes No The sensor measures the saturation temperature of the coil within 1.3 degrees F , 7, and 8 is a pass. Enter N/A if STMS are not ✓ ✓ N/A ✓ Pass ✓ Fail Otherwise enter Pass or Fail Reg: 211-A0060018A-M2500001A-0000 Registration Date/Time: 2012/01/12 15:04:05 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 I IF INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5) Site Address: Enforcement Agency: Permit Number: 79451 HORIZON PALMS CIRCLE, La Quinta CA 92253 City of La Quinta 10-404 Standard Charge Measurement Procedure (for use if outdoor air dry-bulb is above 55°F) Procedures for determining Refrigerant Charge using the Standard Charge Measurement Procedure are available in Reference Residential Appendix RA3.2. As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional form(s) for any additional systems in the dwelling as applicable. • The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure. • The system must meet minimum airflow requirements as prerequisite for a valid refrigerant charge test. • If outdoor air dry-bulb is 55°F or below, the installer must use the Alternate Charge Measurement Procedure. Space Conditioning Systems System Name or Identification/Tag System 1 (must be re -calibrated monthly) Date of Thermocouple Calibration' ii -i-11 i System Location or Area Served Whole House Outdoor Unit Serial # 100415751 Outdoor Unit Make Goodman Outdoor Unit Model ASZ140361 Nominal Cooling Capacity Btu/hr' f 35000 Date of Verification 11-3-11 callbratlon of Diagnostic Instruments Date of Refrigerant Gauge Calibration 11-1-11 (must be re -calibrated monthly) Date of Thermocouple Calibration' ii -i-11 i `must be re -calibrated monthly) measurea remperatures'IrF) 1 i I -IT I r(_� I t !s I Zi f/� System Name or Identification/Tag System i ; ' Supplyy(evaporator leaving) air dry-bulb 45 temperature (T supply, db) Return (evaporator entering) air dry-bulb 69 temperature (Treturn, db) Return (evaporator entering) air wet -bulb 52 temperature (Treturn, wb) Evaporator saturation temperature 30 (Tevaporator, sat) Condensor saturation temperature 85 (Tcondensor, sat) Suction line temperature (Tsuction) 50 Liquid Line Temperature (Tliquid) 77 Condenser (entering) air dry-bulb 90 temperature (Tcondenser, db) Reg: 211-A0060018A-M2500001A-0000 Registration Date/Time: 2012/01/12 15:04:05 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5) Site Address: Enforcement Agency: Permit Number: 79451 HORIZON PALMS CIRCLE, La Quinta CA 92253 City of La Quinta 10-404 Minimum Airflow Requirement Temperature Split Method Calculations for determining Minimum Airflow Requirement for Refrigerant Charge Verification. The temperature split method is specified in Reference Residential Appendix RA3.2. System Name or Identification/Tag System 1 Calculate: Actual Temperature Split = Treturn, 24.00 db - Tsupply,db Target Temperature Split from Table RA3.2-3 21 using Treturn, wb and Treturn, db Calculate difference: Actual Temperature Split - 3 Target Temperature Split = Passes if difference is between -3°F and +3°F or, upon remeasurement, if between -3°F and PASS -100°F Enter Pass or 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 Iden�tification/Tagr;, 4 S ystem .1<i- Calculated Minimum Airfldw Requirement (CFM) Measured �Ai rflow,using RA3 3 procedures (CFM) c l Passes if measured airflow is greater than or equal to the calculated minimum airflow requirement. Enter Pass or Fail Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for fixed orifice metering device systems System Name or Identification/Tag System 1 Calculate: Actual Superheat = Tsuction - Tevaporator, sat Target Superheat from Table RA3.2-2 using Treturn, wb and Tcondenser, db Calculate difference: Actual Superheat - Target Superheat = System passes if difference is between -5°F and +5°F Enter Pass or Fail Reg: 211-A0060018A-M2500001A-0000 Registration Date/Time: 2012/01/12 15:04:05 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 51 Site Address: Enforcement Agency: Permit Number: 79451 HORIZON PALMS CIRCLE, La Quinta CA 92253 City of La Quinta 10-404 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 = 8.0 Tcondenser, sat - Tliquid Target Subcooling specified by manufacturer 9 Calculate difference: -1 Actual Subcooling - Target Subcooling = System passes if difference is between -3°F and +3°F PASS r �"�� J` "- I Enter Pass or Fail PASS w 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 Y System 1 Calculate: Actual Superheat= 20.0 Tsuction - Tevaporator, sat Enter allowable superheat range from manufacturer's specifications (or use range 25 between 4°F and 25°F if manufacturer's specification is not available) '• System passes -.-if actual superheat is -within the" �. �' ` ; r�' r �"�� J` "- I allowable superheat range.` PASS w ,,rw,Enter Pass or Fail ii 1 Reg: 211-A0060018A-M2500001A-0000 Registration Date/Time: 2012/01/12 15:04:05 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: 79451 HORIZON PALMS CIRCLE, La Quinta CA 92253 City of La Quinta 10-404 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: 595145 Date Signed: 11/3/2011 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 II -C' f_. 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) D C S HEATING & AIR CONDITIONING INC Responsible Person's Name: Responsible Person's Signature: Chris Brown Chris Brown CSLB License: 595145 Date Signed: 11/3/2011 Position With Company (Title): Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? Yes No Reg: 211-A0060018A-M2500001A-0000 Registration Date/Time: 2012/01/12 15:04:05 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-21 Duct Leakage Test — Existing Duct System (Page 1 of 2) Site Address: 79451 HORIZON PALMS CIRCLE, La Quinta CA 92253 Enforcement Agency: Permit Number: (System 1) City of La Quinta 10-404 Enter the Duct System Name or Identification/Tag: System 1 Enter the Duct System Location or Area Served: Whole House Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the dwelling. This installation certificate is required for compliance for alterations and additions in existing dwellings to space conditioning systems and duct systems. Note: For existing dwellings, a completely new or replacement duct system can also include existing parts of the original duct system (e.g., register boots, air handler, coil, plenums, etc.) if those parts are accessible and they can be sealed. For a completely new or replacement duct system installed in an existing dwelling, use the Installation Certificate titled "Duct Leakage Test - Completely New or Replacement Duct System. " Duct Leakaae Diaanostic Test - existina duct system Select one compliance method from the following four choices. 1. Measured leakage less than 15% of fan flow 2. Measured leakage to outside less than 10% of Fan Flow 3: Reduce leakage by -60% and conduct smoke and fix all leaks 4`.Fix all accessible leaks using smoke and HERS rater verify Note: (One of Options,l, 2, or 3 must be attempted, before. utilizing Option.4),. Determine/nominal Fan Flow using one of4he following three calculation methods.�`f ✓ ✓ Cooling system method: Size of condenser in Tons 1 3 x 400 1200 CFM d: Thlousands ✓ He ting system meth 2f x'_ Output CapaItyin of Btu/hr = _CFM ✓ procedures: Measured ,system a'irfl w using RA3.3 airflow test CFM -'_• ._�' •� f�:*; :� Option 1 used then: 1 Allowed leakage = Fan Flow 1200 x 0.15 = 180 CFM ' Actual Leakage = 63 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 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: 211-A0060018A-M2100001A-M21A Registration Date/Time: 2012/01/12 15:07:21 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: 79451 HORIZON PALMS CIRCLE, La Quinta CA 92253 Enforcement Agency: Permit Number: (System 1) City of La Quinta 10-404 v Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off du`rilig duct leakage testing. CFI OA ducts that utilize controlled motorized dampers, that open only when OA ventilation is required to meet ASHRAE Standard 62.2, and close when OA ventilation is not required, may be configured to the closed position during duct leakage testing. V All supply -ani dreturn register.boots must beisealed to the drywall if. smoke test is utilized for�'compliance - applies'to�duct leakage compliance option 3 (leakage reduction by 60%) and option 4'(fix all accessible. leaks) described abov,,�e. fY V New'duct installations,.cannot utilize building cavities as" lenums�or platform returns in lieu of ducts. Y a V Mastic and draw bands must be used in combination with cloth backed rubber adhesive duct tape to seal - leaks at all new duct connections 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 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 -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) DESERT COOLER SPECIALIST INC Responsible Person's Name: CSLB License: Chris Brown 1595145 HERS Provider Data Registry Information Sample Group # (if applicable): N/A J tested/verified dwelling not-tested/verified dwelling in la HERS sample group HERS Rater Information CalCERTS Certificate # CCi-1798608584 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: 1/12/2012 CC2004131 Reg: 211-A0060018A-M2100001A-M21A Registration Date/Time: 2012/01/12 15:07:21 HERS Provider: CalCERTS, 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: 79451 HORIZON PALMS CIRCLE, La Quinta CA 92253 City of La Quinta 10-404 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 SUDDIV and Return Plenums of Air Handler System Name or Identification/Tag System i System Location or Area Served Whole House 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 V Yes ,i No r 5/16 inch (8 mm) access hole downstream of evaporative coil in the supply plenum and labeled according to Figure in Section RA3.2.2.2.2. Yes to,1 and 2 is a pass. Enter Pass or Faill ✓ V Pass ✓ Fail STMS - Sensor�ontthe.Evaporator Coil - ,k System Name'or Identification/Tag) � r System i i 3 Yes No' %� The sensor is factory installed, orjfield installed according to manufacturer's is`installed by by Executive r 6 Yes No specifications, or methods/specifications approved the 1. Director. /A r/ The sensor wire is terminated with a standard mini plug suitable for connection,to a 4 f Yes-. No digital thermometer. The sensor mini plug is accessible to the installing technician %r— and the HERS rater without changing the airflow through the condenser coil - " - 5� Yes No When attached to a digital thermometer, the sensor provides an indication of the saturation temperature of the coil. Yes to 3, 4, and 5 is a pass. Enter N/A if STMS are not ✓ -/ N/A ✓ Pass ✓ Fail applicable. Otherwise enter Pass or Fail STMS - Sensor on the Condenser Coil System Name or Identification/Tag System i The sensor is factory installed, or field installed according to manufacturer's 6 Yes No specifications, or is installed by methods/specifications approved by the Executive Director. The sensor wire is terminated with a standard mini plug suitable for connection to a 7 Yes No digital thermometer. The sensor mini plug is accessible to the installing technician and the HERS rater without changing the airflow through the condenser coil 8 Yes 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 ✓ Pass ✓ Fail applicable. Otherwise enter Pass or Fail 7. Reg: 211-A0060018A-M2500001A-M25A Registration Date/Time: 2012/01/12 15:08:52 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 2 of 5) Site Address: Enforcement Agency: Permit Number: 79451 HORIZON PALMS CIRCLE, La Quinta CA 92253 City of La Quinta 10-404 Standard Charge Measurement Procedure (for use if outdoor air dry-bulb is above 55°F) Procedures for determining Refrigerant Charge using the Standard Charge Measurement Procedure are available in Reference Residential Appendix RA3.2. As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional form(s) for any additional systems in the dwelling as applicable. • The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure. • The system must meet minimum airflow requirements as prerequisite for a valid refrigerant charge test. • If outdoor air dry-bulb is 55°F or below, the installer must use the Alternate Charge Measurement Procedure. Space Conditioning Systems System Name or Identification/Tag System 1 (must be re -calibrated monthly) System Location or Area Served Whole House j 1-1-12 r �` !must berre calibrated monthly) Jf Outdoor Unit Serial # 100415751 Outdoor Unit Make Goodman Outdoor Unit Model ASZ140361 Nominal Cooling Capacity Btu/hr 35000 Date of Verification 1-12-12 Lanoration or uiagnostic instruments Date of Refrigerant Gauge Calibration 1-1-12 (must be re -calibrated monthly) Supply'(evaporator leaving),air dry-bulb Date of h&mocouple;Calibration i J j 1-1-12 r �` !must berre calibrated monthly) Jf J J measurea temperatures (-r) ! System Name or Idem fication/Tag System i Supply'(evaporator leaving),air dry-bulb 45 4' t temperature (Tsupply, db) Return (evaporator entering) air dry-bulb 67 temperature (Treturn, db) Return (evaporator entering) air wet -bulb 53 temperature (Treturn, wb) Evaporator saturation temperature 32 (Tevaporator, sat) Condensor saturation temperature 82 (Tcondensor, sat) Suction line temperature (Tsuction) 48 Liquid Line Temperature (Tliquid) 74 Condenser (entering) air dry-bulb 75 temperature (Tcondenser, db) Reg: 211-A0060018A-M2500001A-M25A Registration Date/Time: 2012/01/12 15:08:52 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: 79451 HORIZON PALMS CIRCLE, La Quinta CA 92253 1 City of La Quinta 10-404 Minimum Airflow Requirement Temperature Split Method Calculations for determining Minimum Airflow Requirement for Refrigerant Charge Verification. The temperature split method is specified in Reference Residential Appendix RA3.2. System Name or Identification/Tag System 1 Calculate: Actual Temperature Split = Treturn, 22.00 db - Tsupply, db Target Temperature Split from Table RA3.2-3 19 using Treturn, wb and Treturn, db Calculate difference: Actual Temperature Split - 3 Target Temperature Split = Passes if difference is between -4°F and +4°F or, upon remeasurement, if between -4°F and PASS -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. 1 Calculated Minimum Airflow Requirement (CFM) = Nominal Cooling Capacity (ton) X 300 (cfm/ton) System Name o Identification/Tag Calculated Minimum Airflow Requirement (CFM) !� I // '/ J , Measured•Airflow,us ng RA3.3 procedures (CFM) --4 Passes if measured airflow is greater than or equal to the calculated minimum airflow requirement. Enter Pass or Fail Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for fixed orifice metering device systems System Name or Identification/Tag Calculate: Actual Superheat = Tsuction - Tevaporator, sat Target Superheat from Table RA3.2-2 using Treturn, wb and Tcondenser, db Calculate difference: Actual Superheat - Target Superheat = System passes if difference is between -6°F and +6°F Enter Pass or Fail Reg: 211-A0060018A-M2500001A-M25A Registration Date/Time: 2012/01/12 15:08:52 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-411-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5) Site Address: Enforcement Agency: Permit Number: 79451 HORIZON PALMS CIRCLE, La Quinta CA 92253 City of La Quinta 10-404 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 i Calculate: Actual Subcooling = 8.0 Tcondenser, sat - Tliquid 16.0 Target Subcooling specified by manufacturer 9 Calculate difference: -1 Actual Subcooling - Target Subcooling = 25 System passes if difference is between -4°F and +4°F PASS 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/Tab System 1 Calculate: Actual Superheat,-- 16.0 Tsuction - Tevaporator, sat Enter,allowable superheat range from manufacturer's specifications (or use range 25 between 3°F and 26°F if manufacturer's specification is not,available) System passes,if actual superheat is`within'the �' allowable superheat range /,' % ! V PASS u Enter Pass or Fail Reg: 211-A0060018A-M2500001A-M25A Registration Date/Time: 2012/01/12 15:08:52 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 r INSTALLATION CERTIFICATE CF-4111-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5) Site Address: I Enforcement Agency: Permit Number: 79451 HORIZON PALMS CIRCLE, La Quinta CA 92253 City of La Quinta 10-404 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 595145 HERS Provider Data Registry Information Sample Group # (if applicable): N/A System meets all refrigerant charge and airflow not-tested/verified dwelling in la HERS sample group requirements. PASS 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: 1/12/2012 CC2004131 1 r. V, DECLARATION STATEMENT . I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. • I am the certified HERS rater who performed the verification services identified and reported on this certificate (responsible rater). • The installed feature, material, component, or manufactured device requiring HERS verification that is identified on this certificate (the installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified on the Certificate(s) of Compliance (CF -111) approved by the local enforcement agency. • The information reported on applicable sections of the Installation Certificate(s) (CF -6R), signed and submitted by the person(s) responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -1R) approved by the enforcement aaencv. Builder or Installer information as shown on the Installation Certificate (CF -6111) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) DESERT COOLER SPECIALIST INC Responsible Person's Name: CSLB License: Chris Brown 595145 HERS Provider Data Registry Information Sample Group # (if applicable): N/A J tested/verified dwelling not-tested/verified dwelling in la HERS sample group HERS Rater Information CaICERTS Certificate # CCl-1798608584 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: 1/12/2012 CC2004131 Reg: 211-A0060018A-M2500001A-M25A Registration Date/Time: 2012/01/12 15:08:52 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010