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12-0379 (AR)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 12-00000379 Property Address: 79451 LIGA-`"'� APN: 772-180-069- - - Application description: ADDITION - RESIDENTIAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 55879 T4ht. 4 4 Q" Applicant: Architect or Engineer: Ply BUILDING & SAFETY DEPARTMENT BUILDING PERMIT LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am nsed under ro isions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business a P fessiont o and my License is in full force and effect. License Clask: B / �L' 7583 • OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: (_ 1 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). 1 _ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.)., (_) I am exempt under Sec. B.&P.C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: a Lender's Address: L.QPERMIT Owner: DECOLA,LEE F & MICHAEL VOICE (76 777-7 2 FAX (760) - 011 INSPECTIONS (760) 777-7153 A TRUST Contractor: MORRIS CONSTRUCTION INC, ROP 78930 STARLIGHT LANE BERMUDA DUNES, CA 92203 (760)272-9292 Lic. No.: 867583 Date: 10/15/12 D Q OCT 222012 CITY OF LA QUINTA WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier P3EMPT Policy Number EXEMPT 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, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor ColeeI shall forthwi comply with th seprovispns. l cant "'B✓i�) �isT/O WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. 1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application, the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that thea ova infor tion is correct. I agree to comply with all city and county ordinances and state laws relating that co*tin, hereby authorize representatives of this county to enter upon the above-mentioned prop or ines. at Sign re (Applicant or Agent): !01) !V lluv� VV Application Number . . . . . 12-00000379 ------ Structure Information 653SF CASITA/VB/RES-3/CLASS A -FR [CONV] ----- Other struct info . . . . . CODE EDITION 2010 # BEDROOMS 1.00 FLOOD ZONE NO GARAGE SQ FTG 40.00 ---------------------------------------------------------------------------- 1ST FLOOR SQUARE FOOTAGE 653.00 Permit . . . BUILDING PERMIT Additional desc . . Permit Fee . . . . 441.50 Plan Check Fee 286.98 Issue Date . . . . Valuation 55879 Expiration Date . . 4/13/13 Qty Unit Charge Per Extension BASE FEE 414.50 6.00 4.5000 ---------------------------------------------------------------------------- THOU BLDG 50,001_100,000 27.00 Permit . . . ELECT - ADD/ALT/REM Additional desc . . Permit Fee . . . . 38.66 Plan Check Fee 9.67 Issue Date . . . . Valuation 0 Expiration Date 4/13/13 Qty Unit Charge Per Extension BASE FEE 15.00 653.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 22.86 40.00 .0200 ---------------------------------------------------------------------------- ELEC GARAGE OR NON-RESIDENTIAL .80 Permit . . . MECHANICAL Additional desc . Permit Fee . . . . 57.00 Plan Check Fee 14.25 Issue Date . . . . Valuation . . . . - 0 Expiration Date 4/13/13 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 9.0000 EA MECH FURNACE <=100K 9.00 1.00 4.5000 EA MECH VENT INST/ DUCT ALT 4.50 1.00 9.0000 EA MECH B/C <=3HP/100K BTU 9.00 3.00 6.5000 ---------------------------------------------------------------------------- EA MECH VENT FAN 19.50 Permit PLUMBING Additional desc .-. LQPERMIT Application Number . . . . . 12-00000379 Permit . . . . . . PLUMBING Permit Fee . . . . 51.00 Plan Check Fee 12.75 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 4/13/13 Qty Unit Charge Per Extension BASE FEE 15.00 5.00 6.0000 EA PLB FIXTURE 30.00 1.00 3.0000 EA PLB WATER INST/ALT/REP 3.00 1.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS 3.00 ---------------------------------------------------------------------------- Special Notes and Comments 653SF CASITA ADDITION/VB/RES-3/CLASS A -FR [CONVENTIONAL] THIS PERMIT DOES NOT INCLUDE FIREPLACE OR WROUGHT IRON FENCING. 2010 CALIFORNIA BUILDING CODES. August 20, 2012 5:06:47 PM AORTEGA ---------------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 3.00 ENERGY REVIEW FEE 28.70 STRONG MOTION (SMI) - RES 5:59 Fee summary Charged Paid Credited ---------------------------------------- Due ----------------- Permit Fee Total 588.16 .00 .00 588.16 Plan Check Total 323.65 .00 .00 323.65 Other Fee Total 37.29 .00 .00 37.29 Grand Total 949.10 .00 .00 949.10 LQPERMIT Bin. # G Permit # ' 2 Project Address: • 951 A P. N.uinbcr.,O{{ , • city of: La Qu1n.0 . Rui1&n,-8r Sareiy Divfston :. . P.O. Boy. 1.504, 78-495 Calle Tampico La.Quinta, CA 92253 -:(760) 177-7012 Building Permit Applicatlon and Tradgng §4eet Ll 6PA Owner's Name:. lch* ' Address: �1 • I L A Legal Description: �•4 Contractor. (� Z`�- City, ST, Zip: Telephone: Project Description: CQv� Address: City, ST, Zip: Telephone: State Lia #: City Lic.`#; C Arch, 6ngr.,Designer. L wrl . Address: •Q. 70V� City., ST, Zip: Telephone:&J ID Construction Type:. Occupancy: Project type (circle one): New Add'n Alter Repair Demo State Lic. #: Name of Contact Person: Sq. Ft : 3# Stories: #Unit$: Telephone # of Contact Person:oe / Estimated Value of Project:::15 APPLICANT:. DO NOT WRITE BELOW TH16 UNE # Submittal Plan Sets Req'd Reed TRACKNG PERMrP FEES Pian Check submitted R Item Amount Strgdaiai CaIcs Reviewed, ready for corrections Plan Check Deposit. . Truss Calcs. Called Contact Person Pian Check Balance Tide za Pales. Pians picked up construction Flood plain plan Plans resubmitted... �. Mechatikal Grading plan 2'! Review, ready for rtectio to Electrical Snbco>rtactor List Called Contact Person /t Plumbing Grant Deed Pians picked up ZV SMI. H.O.A. Approval Plans resubmitted i J7• Grading IN HOUSE- Revlew, ready for correction Developer Impact Fee Planning Approval. Called Contact Person 48? A.I.P.P. Pub. Wks. Appr Date of permit issue v School Fees O ti IV Total Permit Feesmt�r �-- el z �Ad �. e fl(o 6111 ,vim .. . 8`?a i nls Ing- Are seg W&4"T ��,J 7//2 ,SPG �f l3 CERTIFICATE OF COMPLIANCE Desert Sands Unified School District 47950 Dune Palms Road Q BERMUDA DUNES r Date 10/16/12 La Quinta, CA 92253 N RANCHO INDIAN WELLS WELLSMIRAGt7 ti DESERT No. 31441 (760) 771-8515 �� PALM UA QUINTA �y �INDIO yeti ® Y Owner Michael & Lee Decola APN # 7760-180-030 Address 79451 Liga Jurisdiction La Quinta City La Quinta Zip Permit # Tract # No. of Units 1 Type Residential Addition Lot # No. Street S.F. Lot # No. Street S.F. Unit 1 79451 Liga 653 Unit 6 Unit 2 Unit 7 Unit 3 Unit 8 Unit 4 Unit 9 Unit 5 Unit 10 Comments Casita Addition At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patiostwalkways, residential additions under 500 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile homes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason: EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Education Code Section 17620 and Government Code 65995 Et Seq. in the amount of $3.20 X 653 S.F. or $2,089.60 have been paid for the property listed above and that building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued. Fees Paid By CC/Bank of America - Roper Morris Check No. 001186123 Bank Name/Recipient of Certificate Telephone Funding Residential By Dr. Sharon P. McGehee Superintendent Fee collected /exempfed by Sha MCGII r Payment Recd $2,089.60 rr; wer/Under Signature NOTICE: Pursuant to Government Code Section 66020(d)(1), this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on which those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier. NOTICE: This Document. NOT VALID without embossed seal Embossed Original - Building Department Applicant Copy - Applicant/Receipt Copy - Accounting r�Q CITRUSUs COURSE HOMEOWNERS ASSOCIATION NOTICE OF APPROVAL March 20, 2012 Lee Decola I RE: 79451 Liga Dear Lee Decola:: Your Request for an architectural change has been approved. Specifically, you have:approval to proceed with the following., Build a casita and outdoor fireplace. We reserve the right to make a final inspection of the change to make sure it matches. the Request you submitted for Approval. Please follow the plan you submitted or submit an additional Request form if you cannot follow the original' plan. Your approval is conditional with the stipulation of the following: Must obtain all necessary permits from the City of La Quinta. You must follow all local building codes and setback requirements when making this change. A Building Permitmay be needed. This can be applied for at the City offices. ' Our approval here. is only based on the aesthetics of your proposed change. This approval should notbe taken as any certification as to .: the construction worthiness or structural integrity of the change you propose. If applicable, please be aware that you are responsible for contacting the appropriate utility companies before digging. Thank you for submitting your application and we look forward to receiving your notice of completion upon commencement of completed work. For your convenience a "notice of completion" -document has been attached. We appreciate your cooperation in submitting this Request for Approval. An attractive Community helps all of us get the full value from our homes when we decide to sell. Sincerely,. Ann Miller Assistant Association Manager Citrus Course HOA . Encl. 1 JUL 0 5 P.O Box 12920 Pahn Desert, CA 92255 * 41-865 Boardwalk, Suite 101, Palm Desert, CA 92255 7601-246,9000 * FAX 760.346.9997 * www.citruscoursehoa.com 7WV LiCITY OF LA QUINTA SUB-CONTRACTOfl LISJOB ADDRESL bah PERMIT NUMBER OWNER—C® 1 —.BUILDER ,° This form shall be hosted on the job with the Building Inspection Card at all times in a cows place. Only persons appearing on this list or their employees are authorized to worl on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance of building permit. For each applicable trade, all information requested below must be completed by applicant. "On File' is not an acceptable resDonse. Trade Classifica tion ConVactor.: Sta e:::ContracY :. t . or's Ucetue . :..; W4tkrs.Com . nsat%ii;)nsixance`:...`' :< Cit .. Busf�)ess License: > .: Company Name Classification (e.g. A, B, C-8) License Number (xxxxxx) Exp. Date Ixx/xx/xx) Carrier Name (e.g. State Fund, CalComp) Policy Number (Format Varies) Exp. Date (xx/xx/xx) License Number (xxxx) Exp. Date: (xx/xx/xx) ' EARTHWORK (C-12) � �� L11iw �t/n'. G'�� 64 /G 3/ /2 &n arjk 0. -.4445 ss S we 3$1151 S �/ s`� /i /O S S�S/O / s/ /3 CONCRETE IC -8) - CALi 13 (s6 LT & f C' 0 9,93 57 y FRAMING .IC -5) �►� (� 13 , G"�7 8 `? �t� S 31 / 3 A" n ^ *i W ��.� S8.%ci i� y 1,0 9 1l J 9 /✓ STRUCT: STEEL- (C-5 ) MASONRY (C•29) i a4 / �D� D 7 513 PLUMBING (C-36) (sat VA -4 71046W 6- C - 3(,- SIS 91f /3 STA fC Cowt� '� BATH; PLASTER 1C-351 v �` C� q C'3S G ( !� a a s 13 �D �i � S?' DRYWALL (C -9)V L4) . 6-35 egg5a3 d 13 !��`f7�y6��- Ile I /� ro6D7 s /3 HyAc(o-2o) X12 0-20 7�D�3 :0, [� S'�ktG K7 00O`fS(v-10 /3 3�farl ELECTR,CAL'(C-10) 's//ii'mpwwS i�`�7fr� >`r�L G-tv q017 q3Ay �M pN P/O ePG1>•% s3/S� s113 zl V 1074 7 % % /'� ROOFlNG lC=s9) >..::.; p►v�.v Cl G(✓� 1 V7g19 s ry 'SHEET METAL (C43) FCO RING 1C►15) ' ..:.' :.:.. K TS G'!.S G �T 3� 7 �J g /2— -� Cli(� WsDGoao4�go� yr r 3r 8 e $ �3 ci:aziiuG �c-� i ' PAtMS ��►� ES C' [? 5 Yv 3 Z I q i2 ce-Ca Gid`( W SDSoZ0361.D0 �3 (sl0 / INSULATION (C-2) . SEWAGE DISP; (C-42) PAINTING (C=33) CERAMIC TILE IC -54) f t%t;4L . CABINETS (C-6) S�Q.c�riutm ` C�- p 1(�, 3I emmgGG FENCING (C-13) LANDSCAPING (C=27) POQL (C-53) To: Attn 1 71-,780 San Jacinto Dr. Ste. E2; Rancho Mirage, Ca: 92270 ph. (760) 834-8860 fax (760) 834-8861 Letter of Transmittal City of La Quinta Today's Date: 8-13-12 78-495 Calle Tampico City Due Date: 8-16-12 La Quinta, CA 92253 Project Address: 79-451 Liga Kay Plan Check #: 12-379 Comments: Structural design content is aaarovable. This Material Sent for: ❑ Your Files ❑ Your Review ❑ Checking Other: ❑ By: John W. Thompson Rancho Mirage Office : ® (760) 834-8860 Other: ❑ 'Y ® Per Your Request ❑ Approval ❑ At the request of: Submittal: ❑ - 1st ❑ 4th ® 2nd ❑ 5th ❑ 3`d ❑ Other: We are forwarding: ® By Messenger ❑ By Mail (Fed Ex or UPS) ❑ Your Pickup Includes: # Of Descriptions: Includes: # Of Descriptions: Copies: Copies: ❑ Structural Plans ® 1 Revised Struct. Plans ❑ Structural Calculations ® 1 Revised Struct. Calcs ® 1 Truss Calcs ❑ Revised Truss w/Ltr. ❑ Soils Report ❑ Revised Soils Report ❑ Structural P/C Comments ❑ Approved Structural Plans ® 1 Redlined Structural Plans ❑ Approved Structural Calcs ® 1 Redlined Structural Calcs ❑ Approved Truss Calcs ❑ Redlined Truss Calcs ® Approved Soils Report ❑ Redlined Soils Reports ❑ Other: Comments: Structural design content is aaarovable. This Material Sent for: ❑ Your Files ❑ Your Review ❑ Checking Other: ❑ By: John W. Thompson Rancho Mirage Office : ® (760) 834-8860 Other: ❑ 'Y ® Per Your Request ❑ Approval ❑ At the request of: CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF -4R -ENV -21 Quality Insulation Installation (QII) - Framing Stage Checklist (Page 1 of 23 Site Address: Enforcement Agency: Permit Number: 79451 Liga, La Quinta CA 92253 City of La Quinta 12-379 L. Quality Insulation Installation (QII) - Framing Stage Checklist Air barrier and preparation for insulation verification inspection must be done at framing stage before insulation is installed. If there are any "No" answers rows not filled out or signatures missing then this is not valid form and cannot be accepted by the building department or HERS rater. If spray foam is used an air barrier is not required NA would be checked. QII credit not allowed if any steel framing or structural framing in the walls of.a conditioned space. FLOOR AIR BARRIER es R® 19 All gaps in the raised floor to unconditioned space or to outside larger than 1/8" filled with foam or caulk. (NA if SPF) IRS_ Po ® I�1C All openings on a second floor including under a tub where the drain penetrates the floor is sealed WALLS AIR BARRIER ® e I o ❑ ISA All gaps in wall exterior sheathing to unconditioned space or to outside larger than 1/8" filled with foam or caulk. (NA if SPF) 10 es o tJA No gaps in sheathing against the garage, attic, or covered patio. All gaps larger than 1/8" filled with foam or caulk. (NA if SPF) es ❑ No ® 19 All gaps in Rim -joists in interior and exterior walls to the outside including holes drilled for electrical and plumbing larger than 1/8" filled with foam or caulk. (NA if SPF) P e Po ❑ NA Rope caulk, foam gasket, or caulking bead around the entire sole plate of the home ® e ❑ IITo ❑ NAT All gaps around the windows are caulked or foamed (stuffing with fiberglass not acceptable) ATTIC INSPECTION es ❑ ' N Po 10 NA Attic (NA rulers appropriate to the material installed evenly throughout the attic to'verify depth. if SPF or batt) fl 4 e r 1 I19rulers Square fif oot of attic r / 250 = 4 minimum number„of rulers installed. Must round up.;Number of ctually installed (NA SPF or batt) ° \ `y � ` Pes `i `� ', A X t /. I F, t � 4 0 a I ALL rulers visible:frommattic access (NA,if.SPF or - batt) ` ) ff jfr � ..I*-*- - Yes. ❑ No ❑ NA Eave vents baffles installed at all eave vents to prevent air movement under or into insulation. (NA if SPF) Yes IQo ❑ NA Area of eave vent baffle is the same or larger than the net free -ventilation area of the eave vent. (NA if SPF) CEILING AIR BARRIER i All draft stops:in place to form a continuous ceiling air barrier no gaps larger than 1/8". (NA if SPF) ® Yes ❑ All drops covered with hard covers. Gaps around or in the hard cover larger than 1/8" filled with foam or caulk. (NA if SPF). e P All recessed light fixtures in non conditioned space IC and air tight (AT) es ❑ IVo All recessed light fixtures are sealed with a gasket or caulk between the housing and the ceiling es o Openings around flue shafts fully sealed with solid ing or flashing and any remaining gaps sealed with fire -rated caulk or sealant. e P Piping shafts openings fully sealed and caulked es IQo Penetrations from wiring in interior walls, electrical boxes, fire alarms etc. sealed with caulk or sealant All duct chases, fireplace chases, and double walls sealed air tight at the ceiling level. All gaps into shafts larger than 1/8” filled with foam or caulk. Special attention paid to ducts entering shafts from ceiling. Reg: 212-N0067113A-E21000o1A-E21A Registration Date/Time: 2013/01/03 15:03:54 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF -411 -ENV -21 Quality Insulation Installation (QII) - Framing Stage Checklist (Page 2 of 2) Site Address: Enforcement Agency: Permit Number: 79451 Liga, La Quinta CA 92253 City of La Quinta 12-379 GARAGE ROOF/CEILING AIR BARRIER FOR TWO STORIES (no conditioned space over garage) ❑ e I P 19 Air barrier installed at joists in garage to house transition (between floors). No gaps larger than 1/8". 1 If SPF used then air barrier Installed gaps not required to be filled. (NA if SPF or conditioned space over garage) GARAGE ROOF/CEILING AIR BARRIER FOR TWO STORIES (conditioned space over garage) es Po o IN NA If insulation is to be installed at subfloor then subfloor has no gaps over 1/8". Air barrier installed at joists in garage to house transition (between floors). (NA if SPF or no conditioned space over garage) es P® NA If insulation is to be installed at ceiling of garage then ceiling and joists to the outside have no gaps lover 1/8". (NA if SPF or no conditioned space over garage.) - - 1 r `it {� 4 - 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 -IR) approved by the enforcement agencv. Builder or Installer information as shown on the Installation Certificate (CF -6R) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) Empire Insulation Responsible Person's Name: CSLB License: Jennifer Carr 1860072 HERS Provider Data Registry Information Sample Group # (if applicable): N/A ® tested/verified dwelling ❑ not-tested/verified dwelling in la HERS sample group HERS Rater Information CaICERTS Certificate # CCl-1798717366 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: 1/2/2013 CC2004131 Reg: 212-N0067113A-E2100001A-E21A Registration Date/Time: 2013/01/03 15:03:54 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF -4R -ENV -22 Quality Insulation Installation (QII) - Insulation Stage Checklist (Page 1 of 3) Site Address: Enforcement Agency: Permit Number: 79451 Liga, La Quinta CA 92253 City of La Quinta 12-379 QII credit not allowed if any steel framing or structural framing in the walls of a conditioned space. Insulation Stave Checklist FLOOR INSULATION es ❑ I o jig All floor joist cavity insulation installed to uniformly fit the cavity side-to-side and end-to-end. (NA if floors slab on grade). es o ® 19 Insulation in full contact with the subfloor, NO gaps. (NA if floors are slab on grade). es P® o 190 9 Insulation in contact with air barrier on all five sides. (ends, sides, back). NA if floors are slab on grade. es P® o 19grade). Batts cut to fit around wiring and plumbing, or split (delaminated). (NA if loose fill, SPF, or slab on e No 9 Batt insulation has continuous support. (NA if loose fill, SPF, or slab on grade). 1 N Insulation R -value same or greater that listed on CF -111. e No NA SPF insulation properly adhered to avoid gaps and provide an air seal Pe .. No SPF (Spray Polyurethane Foam Medium Density) insulation the average thickness is equal to or greater than that listed on the CF -111 and the minimum thickness shall be no more than 1/2 inch less than the required thickness for the R -value. (NA for other forms of insulation). Pe o ,,, SPF list the required floor cavity R -value from CF -1R, R- . List tested average depth of insulation in X 5.811 =; R this is the installed R -value and must be equal to or greater than listed on .CFzlR (NA for other forms of insulation) ❑ e ❑! I� ; ® IVA Measure thickness of_insulation in 6 random measurements. Must be within 1/2 inch of the required depth. J� i ,' k .% - WALL INSULATION .. '. k' MRj"j es o ,� Standard depth, cavities insulation fills cavity and touches air barrier on all six sides. (NA if SPF use and `meets the.`required-R-valu"). j ._ rt �+ '" 4. !y � ❑ e P 9 All double walls and bump -outs, the insulation fills the cavity or additional air barrier installed"so that the insulation fills the cavity. Insulation touches all six sides. (NA if SPF used and meets the required R -value). ; ® e ❑ IVo Behind tub/shower, walls under stairs, and fireplace, insulation touches air barrier on five sides. Not required to fill the space. Cavity required to be air tight. e P NA BATTS, not a single void/depression deeper than 3/4" in ANY stud bay. (NA if loose fill or SPF) ® Yes ❑ No Q NA BATTS, voids/depressions less than 3/4" allowed as long as the area is not greater than 10% of the surface area for each stud bay. (NA if loose fill or SPF). e Ro 19 Loose Fill no gaps or voids of any depth allowed. (NA if batts or SPF). e No Any gaps between studs or insulation larger than 1/8" must be filled with insulation or foam. eAll Rim -joists to the outside insulated. es Q IQo Special attention must be paid to corner channels, wall intersections, and behind tub/shower enclosures insulated to proper R -Value. e P I NIS All skylight shafts'and attic kneewalls insulated with minimum R-19. es ITo ® IVK Insulation in full contact with drywall or wall finish of skylight shafts and attic kneewalls. e Fo Wall insulation same or better than what is listed on the CF -111. PI F 19 JSPF insulation properly adhered to avoid gaps and provide an air seal. Reg: 212-N0067113A-E2200002A-E22A Registration Date/Time: 2013/01/03 15:06:52 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF -4R -ENV -27 Quality Insulation Installation (QII) - Insulation Stage Checklist (Page 2 of 3) Site Address: Enforcement Agency: Permit Number: .79451 Liga, La Quinta CA 92253 1 City of La Quinta r 12-379 Q Yes � No ® No SPF (Spray Polyurethane Foam Medium Density) insulation the average thickness is equal to or greater than that listed on the CF -111 and the minimum thickness shall be no more than 1/2 inch less than the required thickness for the R -value. (NA for other forms of insulation). ❑ e P ® 19 SPF list the required floor cavity R -value from CF -111, R- I5.0 . List tested average depth of insulation in X 5.8R = R this is the installed R -value and must be equal to or greater than listed on CF-iR (NA for other forms of insulation) Pe I o I IRMA Idepth Measure thickness of insulation in 6 random measurements. Must be within 1/2 inch of the required CEILING INSULATION l,e oBATTS there must not be a single gap/void/depression deeper than 3/4". (NA if loose fill or SPF). PBATTS es No voids/depressions less than 3/4" allowed as long as the area is not greater than 10% of the surface area for each stud bay. (NA if loose fill or SPF). Yes P 9 NO gaps or voids allowed for loose fill and SPF. (NA if batts). lies No All ceiling insulation installed to uniformly fit the cavity side-to-side and end-to-end. Yes 0 Insulation in full contact with the ceiling, NO gaps. Pes Po Insulation in contact with air barrier on all five sides. 1110t Pe 'P'- .R I Batts cut to fit!around wiring and plumbing, or split (delaminated). (NA for loose fill or SPF). Yes ' ❑ �`NX Batts taller than the trusses must expand so that they touch each other over the trusses. (NA for inose fill or SPF)..' SPF the average thickness is equal to`or greater than that listed on the CF, -1R and theminimum thickness, shall :be no more than 1/2'�inch less than required thickness for the R=value. (NA if loose. fiI l o�b'atts).;� ` C dl lies No ® �NA,� Insulation fullyf ills cavity below any plywood platform or cat -walk: If SPF used then minimum 3f inches�j(NA+if no platforms or,.fel cat;walks) •' "` Y ` ti: ; "'w` _ _. ® Attic access, gasketed Yes w � o Attic access insulated with rigid foam or batt insulation using adhesive or mechanical fastener. R -value same as ceiling R -value listed on CF -1R ® e P Recessed light fixtures covered full depth with insulation. If SPF used then other forms of insulation used to cover or enclosed in a box fabricated from 1/2 -inch plywood, 18 ga. sheet metal, 1/4 -inch hard board'or drywall e P Wall insulation same or better than what is listed on the CF -1R es ® NA Loose Fill Insulation at proper depth - insulation rulers visible and indicating proper depth and R -value for blown in insulation. (NA for batts or SPF). es P® IVA Loose Fill Insulation uniformly covers the entire ceiling (or roof) area from outside of all exterior walls. (NA for batts or SPF). es No ® NA Loose -fill mineral fiber insulation meets or exceeds manufacturer's minimum weight and thickness requirement for the target R -value. Target R -value 38.0 Manufacturer's minimum required weight for the target R -value (pounds -per -square foot). Sample weight (pounds per square foot). es Po No ® NA Manufacturer's minimum required thickness at time of installation (inches) Manufacturer's minimum required settled thickness (inches). Number of days since loose -fill insulation was installed (days). At the time of installation, the insulation shall be greater than or equal to the manufacturer's minimum Initial insulation thickness. If the HERS rater does not verify the insulation at the time of installation, and if the loose -fill insulation has been in place less than seven days the thickness shall be greater than the manufacturer's minimum required thickness at the time of Installation less 1/2 inch to account for settling. If the insulation has been in place for seven days or longer the insulation thickness shall be greater than or equal to the manufacturer's minimum required settled thickness. Minimum thickness measured (inches). Reg: 212-N0067113A-E2200002A-E22A Registration Date/Time: 2013/01/03 15:06:52 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF -4R -ENV -22 Quality Insulation Installation (QII) - Insulation Stage Checklist (Page 3 of 3) Site Address: Enforcement Agency: Permit Number: 79451 Liga, La Quinta CA 92253 City of La Quinta 12-379 GARAGE ROOF/CEILING INSULATION FOR TWO STORIES(no conditioned space over garage) es F ® 19 Insulation installed at joists against the air barrier in the garage to house transition. All wall insulation 1 requirements above must be met. (NA if conditioned space over garage). GARAGE ROOF/CEILING INSULATION FOR TWO STORIES(conditioned space over garage) ❑ Pe � IVo 9 If insulation is to be installed at subfloor then the insulation must also be installed at joisagainst ts the air barrier in the garage to house transition. All ceiling and wall insulation requirements above must be met. (NA if no conditioned space over garage). es F?R ® If insulation is to be installed at ceiling of garage then the joists to the outside must be insulated and all the insulation requirements listed above must be met. (NA if no conditioned space over garage). e No 19 SPF insulation properly adhered to avoid gaps and provide an air seal ❑ e to 9 SPF (Spray Polyurethane Foam Medium Density) insulation the average thickness is equal to or greater than that listed on the CF -111 and the minimum thickness shall be no more than 1/2 inch less than the required thickness for the R -value. (NA for other forms of insulation). ❑ e P ® IP SPF list the required floor cavity R -value from CF -1R, R- . List tested average depth of insulation in X 5.811 = R this is the installed R -value and must be equal to or greater than listed on' CF -111 (NA for other forms of insulation) es o ® 19 Measure thickness of insulation in 6 random measurements. Must be within 1/2 inch of the required depth WE - i fi fir' 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 -111) approved by the enforcement agency. Builder or Installer information as shown on the Installation Certificate (CF -611) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) Empire Insulation Responsible Person's Name: CSLB License: 3ennifer Carr 1860072 HERS Provider Data Registry Information Sample Group # (if applicable): N/A IR tested/verified dwelling ❑ not -tested) verified dwelling in a HERS sample group HERS Rater Information CalCERTS Certificate # CCl-1798717366 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: 1/2/2013 CC2004131 Reg: 212-N0067113A-E2200002A-E22A Registration Date/Time: 2013/01/03 15:06:52 HERS Provider: C'a10ERTS, Inc. 2008 Residential Compliance Forms March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-20 Duct Leakage Test - Completely New or Replacement Duct System (Page 1 of 2) Site Address: I Enforcement Agency:712-379 Permit Number: 79451 Liga, La Quinta CA 92253 (System 1 (Casita)) City of La Quinta , Enter the Duct System Name or Identification/Tag: System 1 (Casita) 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 certificate is required for compliance for completely new duct systems installed in new dwelling construction, and also for completely new or replacement duct systems in existing dwellings. 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. Duct Leakaap Diannnctir Tact - rmmnlataly now nr ranlm•• mnt- A-4 wcta■r■ Enter a value for the Allowed Leakage (CFM) for the duct system leakage verification. The value entered must be the VLLDCS criteria or one of the three calculated leakage rates described below. Verified Low Leakage Ducts in Conditioned Space (VLLDCS) Compliance Credit. If compliance credit for Allowed verified low leakage ducts in conditioned space is shown in the special features section of the CF-iR, the leakage to outside test method must be used to verify duct leakage (refer to RA3.1.4.3.4), and 25 CFM must Leakage be entered for Allowed Leakage. (CFM) Allowed leakage calculation - (select one calculation method from this section). Use 6% (leakage factor = 0.06) for calculations. When utilizing Low Leakage Air Handler (LLAH) credit, the allowed duct leakage may be specified by the CF -1R to be less than 6%, in which case the user-specified leakage rate must be used in the calculations below. For example, if,the user-specified leakage (specified as a percentage of fan airflow) is reported on the CF -1R as 3%, then+use aleakage factor of 0.03 in the calculations below. ® Cooling system method: Nominal capacity of condenser in Tons 3 rx4000 x leakage factor =, 2 CFM r, ❑ Heatinasyit�E m method:` 21.7 x J Output Capacity' n Thousands of Btu/hr x leakage'factor = oo'..CFM ❑ Measured airflow)method (RAM) ` , � Enter measuredfan flow in,CFM here - x leakage factor =: CFM r Enter value for Actual leakage (CFM) in the right column, from measurement using applicable duct leakage 'procedure Actual Leakage pressurization •test from Reference Residential Appendix RA3.1(CFM @ 25 Pa). w , (CFM) 3 List Actual Leakage from duct leakage test(CFM) 48 Pass if Actual Leakage is less than Allowed Leakage ®Pass 13 Fail For complete replacement of duct systems only, if the 6 percent leakage rate criteria cannot be met, a smoke test should be performed to verify that the excess leakage is coming only from a pre-existing furnace cabinet (air handler cabinet), and not from otheraccessible portions of the duct system. A HERS rater must verify the installation (No sampling allowed). List Actual Leakage from smoke test(CFM) Pass if all accessible leaks (except for existing air handler) are sealed using smoke ❑ Pass ❑ Fail Reg: 212-N0067113A-M2000003A-M20A Registration Date/Time: 2013/01/03 15:08:00 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms August 2009 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-20 Duct Leakage Test - Completely New or Replacement Duct System (Page 2 of 2) Site Address: I Enforcement Agency: Permit Number: 79451 Liga, La Quinta CA 92253 (System 1 (Casita)) I City of La Quinta 12-379 Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off during duct eakage testing. CFI OA ducts that';utilie controlled motorized dampers, that open only when OA ventilation is required to meet ASHRAE Standard 62.2, and close when OA ventilation is not required, may be configured to the closed position during -duct leakage testing. ® All supply and return register boots must be sealed to the drywall ® New duct installations cannot utilize building cavities as plenums or platform returns in lieu of ducts. Fuc and draw" bands must be used in .combination with Cloth backed,, a'dhesiveduct Pape to'seM leaks at uct connections. 44 �; it ; DECLARATION STATEMENT; 1 Y • I certify under penalty'. of perjury,,:under'the laws of the'State of California;"the information provlded on this form is true and correct • I am the certified -HERS rater.who performed the.verification services identified and reported.on this certificate (responsible rater) • The installed feature, material,.component, or manufactured device requiring HERS verification that is identified on this certificate (the installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified on the Certificate(s)^of Compliance (CF -1R) approved by the local enforcement agency. • The information reported on applicable sections of the Installation Certificate(s) (CF -6R), signed and submitted by the person(s) responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -SR) 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) ADAM SIMMONS Responsible Person's Name: CSLB License: Donna Simmons 780534 HERS Provider Data Registry Information Sample Group # (if applicable): N/A ® tested/verified dwelling - ❑ not-tested/verified dwelling in la HERS sample group HERS Rater Information CaICERTS Certificate # CCI -1798717366 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: 1/2/2013 CC2004131 Reg: 212-N0067113A-M2000003A-M20A Registration Date/.Time: 2013/01/03 15:08:00 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-2 HSPP/PSPP Installation: Fan Watt Draw Test (Page 1 of 2) Site Address: Enforcement Agency: Permit Number: 79451 Liga, La Quinta CA 92253 City of La Quinta 12-379 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. Hole for the placement of a Static Pressure Probe (HSPP), and Permanently installed Static Pressure Probe (PSPP) in the supply plenum When the Certificate of Compliance (CF1R )indicates Cooling Coil Airflow or Fan Watt Draw verification are required, HSPP or PSPP are required to be installed in each air handler in the dwelling. Procedures for installing HSPP and PSPP are described in Reference Residential Appendix RA3.3. This measure requires verification by a HERS rater. Select one method from the two choices below for compliance with the HSPP/PSPP requirement for this dwelling. ® HSPP 1/4 inch (6 mm) hole labeled and located downstream of the evaporator coil in the supply ® Diagnostic Fan Flow Using Flow Capture Hood according to the procedures in RA3.3.3.1.3 System Name or Identification/Tag plenum as shown in the figure in Section RA3.3.1.1. 1/4 inch (6 mm) hole equipped with a permanently installed pressure probe, labeled and located p PSPP downstream of the evaporator coil in the supply plenum as shown in the figure in Section RA3.3.1.1. System Name or Identification/Tag System 1 (Casita) System Location or Area Served whole house Nominal Cooling Capacity (ton) of the outdoor unit. Confirm that a HSPP or PSPP has been Enter the minimum airflow requirement from the CF -111 (CFM/ton). installed on the air handler per the PASS requirements of RA3.3.1.1. Calculate the target minimum airflow for the test by multiplying the CFM/ton Enter Pass or Fail criteria specified on the CF -111 by the nominal cooling capacity of the outdoor Cooling Coil Airflow Verification When the Certificate of Compliance indicates Cooling Coil Airflow verification is required, the procedures for measuring the cooling coil airflow must be performed as specified in Reference Residential Appendix RA3.3. Results of the cooling coil airflow diagnostic test must be entered in the table`below:.This measure requires verification by a HERS -rater. - Select one method from the -three choices below for'compliance.with the Cooling Coil Airflow test requirement for this dwelling: ❑ Diagnostic Fan Flow:Using Plenum Pressure Matching according to the procedures in RA3.3.3.1.1 ❑ Diagnostic Fan,Flow Using Flow Grid Measurement according to the procedures in RA3.3.3.1.2 ® Diagnostic Fan Flow Using Flow Capture Hood according to the procedures in RA3.3.3.1.3 System Name or Identification/Tag System 1 (Casita) System Location or Area Served whole house Nominal Cooling Capacity (ton) of the outdoor unit. 3 Enter the minimum airflow requirement from the CF -111 (CFM/ton). 350 CFM/ton Calculate the target minimum airflow for the test by multiplying the CFM/ton criteria specified on the CF -111 by the nominal cooling capacity of the outdoor 1050 unit (ton). Target (CFM) Enter the diagnostically tested airflow (CFM). 1224 Tested (CFM) The system complies if Tested (CFM) is equal or greater than Target (CFM). Enter Pass or Fail PASS Reg: 212-N0067113A-M2200005A-M22A Registration Date/Time: 2013/01/03 15:08:47 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-2 HSPP/PSPP Installation: Fan Watt Draw Test (Page 2 of 2) Site Address: Enforcement Agency: Permit Number: 79451 Liga, La Quinta CA 92253 City of La Quint a 12-379 Fan Watt Draw Verification When the Certificate of Compliance indicates Fan Watt Draw verification is required, the procedures for measuring the Fan Watt Draw must be performed as specified in Reference Residential Appendix RA3.3. Results of the Fan Watt Draw diagnostic test must be entered in the table below. This measure requires verification by a HERS rater. Note: Fan watt draw must be measured simultaneously with cooling mil airflow. The fan watt draw measurement and cooling coil airflow measurement must simultaneously meet or exceed their target criteria specified by the CF -IR for the dwellino. Select one method from the two choices below for compliance with the Fan Watt Draw test requirement for this dwelling. ® Portable Watt Meter Measurement according to the procedures in RA3.3.2.2.1 p Utility Revenue Meter Measurement according to the procedures in RA3.3.2.2.2 System Name or Identification/Tag System 1 Donna Simmons 1780534 HERS Provider Data Registry Information Sample Group # (if applicable): N/A (Casita) t-tested/verified dwelling in 7Rn System Location or Area Served whole house HERS Rater Company Name: Energy Driven Solutions, Inc. Responsible Rater's Name: Enter the air handler Tested (CFM) from the cooling coil airflow test table 1224 David Bricker Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 1/2/2013 above. Enter the fan watt draw requirement from the CF -1R (Watt/CFM). .58 Watt/CFM Calculate the target maximum Watt draw for the test by multiplying the Watt/CFM criteria specified on the CF -111 by the air handler Tested (CFM). 709.92 Target (CFM) Enter the diagnostically tested Watt draw (Watt). 553 Tested (Watt) The system complies if Tested (Watt) is less than or equal to.Target (Watt) PASS Enter Pass or Fail 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 -SR) 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 -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) ADAM SIMMONS Responsible Person's Name: CSLB License: Donna Simmons 1780534 HERS Provider Data Registry Information Sample Group # (if applicable): N/A ®tested/verified dwelling t-tested/verified dwelling in 7Rn RS sample group HERS Rater Information Ca10ERTS Certificate # CC1-1798717366 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: 1/2/2013 CC2004131 Reg: 212-N0067113A-M2200005A-M22A Registration Date/Time: 2013/01/03 15:08:47 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-23 Verification of High EER Equipment (Page 1 of 1) Site Address: Enforcement Agency: Permit Number: 79451 Liga, La Quinta CA 92253 City of La Quinta 12-379 veriTication of High EER Equipment Procedures for verification of High EER Equipment are described in Reference Residential Appendix RA3.4. For dwelling units with multiple systems, the procedures must be applied to each system separately. 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 dwellin4 as anvlicable. 1 System Name or Identification/Tag System 1 Responsible Person's Name: CSLB License: Donna Simmons 1780S34 HERS Provider Data Registry Information (Casita) ® tested/verified dwelling ❑ not-tested/verified dwelling in la 2 System Location or Area Served whole house HERS Rater Company Name: Energy Driven Solutions, Inc. Responsible Rater's Name: 3 Certified EER Rating of the installed equipment (Btu/Watt-hr) 13 Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 1/2/2013 CC2004131 4 Make and Model Number of the installed Outdoor Unit D&N NXA636GKA 5 Make and Model Number of the installed Inside Coil Aspen ACE36D44 6 Make and Model Number of the installed Furnace or Air Handler. D&N GSMXL0701716 7 Minimum Equipment EER required for compliance as reported on the CF -1R 11.9 ® When a high EER system specification includes a time delay relay, the installation of the time delay relay must be verified for compliance credit. Refer to Reference Residential Appendix RA3.4.3 for the Time Delay Relay Verification Procedure. ® When installation of specific matched equipment is necessary to achieve a high EER, installation of the specific equipment must be verified for compliance credit. Refer to Reference Residential Appendix RA3.4.3 for the Matched Equipment Verification Procedure. If the Certified EER Rating in row 3 is equal to or greater than the 8 required minimum EER in row 7,Ahe unit complies. PASS 7 1 1 - , If the unit complies enter PassF 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 -111) approved by the enforcement aoencv. Builder or Installer information as shown on the Installation Certificate (CF -611) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) ADAM SIMMONS Responsible Person's Name: CSLB License: Donna Simmons 1780S34 HERS Provider Data Registry Information Sample Group # (if applicable): N/A ® tested/verified dwelling ❑ not-tested/verified dwelling in la HERS sample group HERS Rater Information CaICERTS Certificate # CCI -1798717366 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: 1/2/2013 CC2004131 Reg: 212-N0067113A-M2300006A-M23A Registration Date/Time: 2013/01/03 15:10:54 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 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 Liga, La Quinta CA 92253 City of La Quinta 12-379 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 Suonly and Return Plenums of Air Handler System Name or Identification/Tag System 1 System 1 (Casita) ] - System Location or Area Served whole house 3 ❑ Yes 1 ® Yes ❑ No t 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 0 No 5/16 inch (8 mm) access hole downstream of evaporative coil in the supply plenum and labeled according to Figure in Section RA3.2.2.2.2. Yes;to 1 and 2 is a pass. Enter Pass or Faill ✓ ® Pass ✓ ❑Fail STMS : Sensor own the Evaporator: CoilWr�s .�""''1 �^a System` Name or Identification/Tagi ( + `' System 1 ] - (Casita)- 3 ❑ Yes �� p No The sensor is factory installed, or field installed according to. manufacturer s,,.^^ spedfications�or is installediby`inethods/specifications approved by the Executive 6 ❑ Yes ❑ No specifications, or is installed by methods/specifications approved by the Executive Director. "T The sensor wire is terminated with a.standard mini plug suitable for connection to a 4 ❑ 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 5 ❑Yes , ❑ No "When attached to a digital thermometer, the sensor provides an indication of the saturation temperature of the coil. Yes to 3, 4, and 5 is a pass. Enter'N/A if STMS are not applicable. Otherwise enter Pass or Fail ✓ ®N/A ✓ ❑ Pass ✓ 13Fail STMS - Sensor on the Condenser Coil System Name or Identification/Tag System 1 (Casita) 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 applicable. Otherwise enter Pass or Fait ® N/A ✓ ❑ Pass Fail Reg: 212-N0067113A-M2500007A-M25A Registration Date/Time: 2013/01/03 15:13:04 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 Reg: 212-N0067113A-M2500007A-M25A Registration Date/Time: 2013/01/03 15:13:04 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: 79451 Liga, La Quinta CA 92253 City of La Quinta 12-379 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 Conditionina Svstems System Name or Identification/Tag System 1 (Casita) (must be re -calibrated monthly) Date of, Thermocouple, Calibration f J 12-15-12 } t' System Location or Area Served whole house t A Outdoor Unit Serial # E124402485 Outdoor Unit Make D&N Outdoor Unit Model NXA636GKA Nominal Cooling Capacity Btu/hr 35200 Date of Verification 1-2-13 a.aI auUn v1 v1ay91U2u46 anscrume"L5 Date of Refrigerant Gauge Calibration 12-15-12 (must be re -calibrated monthly) Date of, Thermocouple, Calibration f J 12-15-12 } t' (must be re -calibrated monthly) t A I'TC0.&U9CU 5CF"LPCUalUrC5,u7r/ I .' - 7 ` ? 1 . CI %. rZ System Name or Identification/Tag System i y >- Supply (evaporator leaving),.air dry-bulb temperature (Tsupply, suPPIY, db Return (evaporator entering) air dry-bulb temperature (Treturn, db) ) Return (evaporator entering) air wet -bulb temperature (Treturn, wb) - 11 Evaporator saturation temperature. 28 (Tevaporator, sat) Condensor saturation temperature 70 (Tcondensor, sat) Suction line temperature (Tsuction) 50 Liquid Line Temperature (Tliquid) 63 Condenser (entering) air dry-bulb 70 temperature (Tcondensor, db) .0 a Reg: 212-N0067113A-M2500007A-M25A Registration Date/Time: 2013/01/03 15:13:04 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of S) Site Address: Enforcement Agency: Permit Number: 79451 Liga, La Quinta CA 92253 City of La Quinta 12-379 Minimum Airflow Requirement Temperature Split Method Calculations for determining Minimum Airflow Requirement for Refrigerant Charge Verification. The temperature split method is specified in Reference Residential Appendix RA3.2. System Name or Identification/Tag Calculate: Actual Temperature Split = Treturn, db - Tsupply, db Target Temperature Split from Table RA3.2-3 using Treturn, wb and Treturn, db Calculate difference: Actual Temperature Split - Target Temperature Split = Passes if difference is between -4°F and +4°F or, upon remeasurement, if between -4°F and -100°F Enter Pass or 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 a° System 1 (Casita) Calculated Minimum AirrfloAj&'. equ rem nt.(CFM) 10 0 Measured^Airflow,using RA3.3 procedures (CFM) t 1224' J1 Passes if measured airflow is greater than or equal to the calculated minimum airflow PASS requirement. i Enter Pass or Fail n 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 Fai Reg: 212-N0067113A-M2500007A-M25A Registration Date/Time: 2013/01/03 15:13:04 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 [NSTALLATION CERTIFICATE CF-4R-MECH-2'. Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of Sj Site Address: Enforcement Agency: Permit Number: 79451 Liga, La Quinta CA 92253 City of La Quinta 12-379 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 (Casita) Calculate: Actual Subcooling = 7.0 Tcondenser, sat - Tliquid Target Subcooling specified by manufacturer 10 Calculate difference: -3 Actual Subcooling - Target Subcooling = System passes if difference is between -4°F and +4°F PASS Enter Pass or Faill 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 (Casita) Calculate: Actual Superheat = 22.0 Tsuction - Tevaporator, sat Enter allowable superheat range from manufacturer's specifications (or use range 3-26 between 3°F and 26°F if manufacturer's specification is not available) System passes if actual superheat is, 'within -the allowable superheat range 1' PASS ^Enter Pass or Fail: Reg: 212-N0067113A-M2500007A-M25A Registration Date/Time: 2013/01/03 15:13:04 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-4R-MECH-2E tefrigerant Charge Verification - Standard Measurement Procedure (Page 5 of S, Site Address: Enforcement Agency: Permit Number: 79451 Liga, La Quinta CA 92253 City of La Quinta 12-379 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 (Casita) 780534 HERS Provider Data Registry Information Sample Group # (if applicable): N/A TR System meets all refrigerant charge and airflow ❑ not-tested/verified dwelling in a 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: 1/2/2013 CC2004131 DECLARATION STATEMENT • I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. • I am the certified HERS rater who performed the verification services identified and reported on this certificate (responsible rater). • The installed feature, material, component, or manufactured device requiring HERS verification that is identified on this certificate (the Installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified on the Certificate(s) of Compliance'(CF-1R) approved by the local enforcement agency. • The information reported on applicable sections of the Installation Certificate(s) (CF -611), signed and submitted by the person(s) responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -1R) approved by the enforcement aoencv_ Builder or Installer information as shown on the Installation Certificate (CF -6R) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) ADAM SIMMONS Responsible Person's Name: CSLB License: Donna Simmons 780534 HERS Provider Data Registry Information Sample Group # (if applicable): N/A TR tested/verified dwelling ❑ not-tested/verified dwelling in a HERS sample group HERS Rater Information CaICERTS Certificate * CCI -1798717366 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: 1/2/2013 CC2004131 Reg: 212-N0067113A-M2500007A-M25A Registration Date/Time: 2013/01/03 15:13:04 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010