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10-0288 (MECH).r° P.O. BOX 1504 78-495 CALLE TAMPICO . LA QUINTA, CALIFORNIA 92253 Application Number:" 10-00000288 Property Address: 54865 AVENIDA RAMIREZ APN: \ 774 -295 -018 -6 -000000 - Application description:.. MECHANICAL Property Zoning: COVE RESIDENTIAL Application valuation: . 5685 Applicant: _ Architect or Engineer BUILDING & SAFETY DEPARTMENT BUILDING PERMIT' LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of -Division 3 of the Business and Professionals Code, and my License is in full force and effect. License Class: C20 P Lie No.: 374937 Date: Contrac7 ��yc�/ t 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 I, as owner of the property, or my employees with wages as their sole compensation,_will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code:- The ' Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build'or improve for the purpose of sale.). (_ 1. 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: Lender's Address: LQPERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 4/07/10 Owner: BEAL KEN & JEANETTE 54865 AVENIDA RAMIREZ q LA QUINTA, CA 92253 ( l :Contractor: PALM DESERT AIR COND CO b:J ` Q111, 42081 BEACON HILL apt PALM DESERT, CA 92211 (760)346-0677 LiC. No.: 374937 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 SOUTHERN INS Policy Number WSIO03802-01 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 Code, I shall forthwith ply with those provisions. _ Date: 76LC Applicanl—�_ 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 1$100,0001. IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S'FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. 1 . Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application, the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of,La Quinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced . within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I. have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upon the above-mentioned property for inspection purpose Date:. 7 ,Signature (Applicant or Age?"-- ,,;- r Application Number .10-00000288 Permit . . . MECHANICAL Additional desc ". Permit Fee'- 33.00 Plan Check Fee 8.25 Issue Date ". . . . Valuation 0 Expiration Date 10/04/10 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 --__--,--____-•. -_._._. ---------------__--•- --- - - -REPLACE ONE (1) HVAC --4::0 'SPLIT 'SYSTEM "12 SEER. ----------------------------------------------------------------------------- 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 ..00 .00 8.25 .8.25 Other Fee Total 1.00 00 .00- 1.00 Grand Total 42.25 .00 .00 42.25 Prescriptive Certificate of Compliance: Residential CF-1R-ALT Residential Alterations Page 1 of 1 Project Name: Climate Zone # of Stories �) 5aAA_. E 3;7- > General Information: Site Address: — '�6 6 1 Date Enforcement Agency: 14 /_7 Building Type :,%,'�i ngle Family ❑ Multi Family Front Orientation: ❑ N O E O W ❑ S Project Type: O Alteration MVAC Replacement O Duct Replacement 0 Conditioned Floor Space (CFS): NOTE: This form is not to be used for new construction or additions. HVAC Systems — Heatin : Duct Insulation Thermostat Configuration (Split Equipment Type Capacity AFUE HSPF R-Value Type or Package) HVAC Systems — Coo lin : Pipe Insulation Thermostat Configuration (Split Equipment Type Capacity SEER EER R-Value Type or Package) Cfi�Q CPO b HERS Verification Summary: Duct Sealing & Testing — HERS verification is required for this measure. XYes ❑ No In Climate Zones 2 and 9-16, if more than 40 linear feet of new or replacement ducts are installed in unconditioned space, the ducts are to be sealed per §152(b)1 Dii and the newly installed ducts are to be insulated per §151(010.. O Exception: Existing duct systems that are extended, which are constructed, insulated or sealed with asbestos. ❑ Yes XNo In Climate Zones 2 and 9-16, if the existing space-conditioning system (HVAC equipment and ducting) is replaced, the ducts are to be sealed per §152(b)1 Di. O No In Climate Zones 2 and 9-16, if the existing HVAC equipment is replaced (including the replacement of the air .0—yes handler, outdoor condensing unit of a split system, cooling or heating coil, or the furnace heat exchanger) the ducts are to be sealed per §152(b)1 E. O Exception: Duct systems that are documented to have been previously sealed confrrrned through HERS verification in accordance with procedures in the Reference Residential Appendix RA3. O Exception: Duct systems with less than 40 linear feet In unconditioned space. ❑ Exception: Existing duct systems are constructed, insulated or sealed with asbestos. Refrigerant Charge – Split System – HERS verification is required for this measure. Yes ❑ No In Climate Zones 2 and 8-15, when the existing HVAC equipment is replaced (includi-ng the replacement of the air handler, outdoor condensing unit of a split system A/C or heat pump, cooling or heating coil, or the furnace heat exchan er) a refrigerant charge measurement shall be verified per §152 b 1 F. Central Fan Integrated (CFI) Ventilation System and Fan Watt Draw The ventilation requirements of §150 o do not apply to existing residential homes. Ducted Split Systems – Air Conditioners and Heat Pumps: Airflow – HERS verification is required for this measure. ❑ Yes If No In Climate Zones 10 through 15, when the existing space-conditioning system (HVAC equipment and ducting) is replaced, the airflow and fan waft draw shall be verified per §152 b 1 Ci to meet the requirements of §151 7B. Documentation Author's Declaration Statement I certify that this Certificate of Compliance documentation is accurate and co Name: Signature Company: / Date: rj l D Address: G gEW--Gh H-( City, State, Zip Code: V r � Phone: Registration Number: Registration Date & Time: HERS Provider: 2008 Residential Compliance Forms , PDAC January 2010 J1 Bin # Qty of La Quinta Building 8L Safety Division P.O. Box 1504, 78-495 Calle Tampico La.Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # j Project Address: 54-865 AVENIDA RAMIREZ Owner's Name: KEN & JEANETTE BEAL A. P. Number: Address: 54-865 AVENIDA RAM REZ Legal Description: Contractor: Palm Desert Air Conditioning & Heating Company City, ST, Zip: LA QUINTA, CA 92253 Telephone: "..::��:'7.?:>.�.:u.';�:>:�v:v"::;:':'.>"::':�•"�t"rz:::<":>:`v'�:'?:: Address: 42081 Beacon Hill Project Description: City, ST, Zip: Palm Desert, CA 92211 REPLACE ONE 1 4.0 TON SPLIT Telephone: (760 ) 346-0677 ;.:•::::;: SYSTEM. State Lie. # : 374937 City Lie. #: 100886 Arch., Engr., Designer: Address: City., ST, Zip: Telephone: .. State Lie. #: .. _ .,•risj/%l.•[:�a�.:;,,7C`•'2'>.ik;�Y:gg:>: `s'>':>:»M %: :«> <?'.:>s's r'`.^<> : :•.:;;>.:c:<?:;s:?h:?::. Construction Type: Project a circle one J typ ( ). New Add'.n Alter Repair Demo Name of Contact Person: KARL BROWN Sq. Ft.: #I Stories: #Units: Telephone # of Contact Person:. (760) 346-0677 Estimated Value of Project: 5,68.5 APPLICANT:. DO NOT WRITE BELOW THIS LINE ' #.. .Submittal _ Req'd . Rec'd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calks. Reviewed, ready for corrections Plan Check III eposit Truss Calks. Called Contact Person Plan Check Balance Title 24 Calcs. Plans picked up Construction Flood plain plan Pians resubmitted Mechanical Grading plan 2a° 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 Prescriptive Certificate of Compliance: Residential CFA R -ALT Residential Alterations Page 1 of 1 Project Name: Climate Zone # of Stories �) General Information: Site Address: .- 176 S� lN.t Y� c�. P1.1 1 Date Enforcement Agency: (7 Building Type:3'Lingle Family ❑ Multi Family Front Orientation: ❑ N ❑ E ❑ W ❑ S Project Type: ❑ Alteration MVAC Replacement ❑ Duct Replacement ❑ Conditioned Floor Space (CFS): NOTE: This form is not to be used for new construction or additions. HVAC Systems — Heatin : Duct Insulation Thermostat Configuration (Split Equipment Type Capacity AFUE HSPF R -Value Type or Package) 6-d dP,---( s HVAC Systems — Coo lin : Pipe Insulation Thermostat Configuration (Split Equipment Type Capacity SEER EER R -Value Type or Package) P s' HERS Verification Summary: Duct Sealing & Testing — HERS verification is required for this measure. PYes ❑ No In Climate Zones 2 and 9-16, if more than 40 linear feet of new or replacement ducts ere installed in unconditioned space, the ducts are to be sealed per.§152(b)1 Dii and the newly installed ducts are to be insulated per §151(f)10. ❑ Exception: Existing duct systems that are extended, which are constructed, insulated or sealed with asbestos. ❑ Yes XNo In Climate Zones 2 and 9-16, if the existing space -conditioning system (HVAC equipment and ducting) is replaced, the ducts are to be sealed per §152(b)1Di. Yes ❑ No In Climate Zones 2 and 9-16, if the existing HVAC equipment is replaced (including the replacement of the air handler, outdoor condensing unit of a split system, cooling or heating coil, or the furnace heat exchanger) the ducts are to be sealed per §152(b)1 E. ❑ Exception: Duct systems that are documented to have been previously sealed confirmed through HERS verification in accordance with procedures in the Reference Residential Appendix RA3. ❑ Exception: Duct systems with less than 40 linear feet in unconditioned space. ❑ Exception: Existing duct systems are constructed, insulated or sealed with asbestos. Refrigerant Charge — Split System — HERS verification is required for this measure. Cd Yes ❑ No In Climate Zones 2 and 8-15, when the existing HVAC equipment is replaced (including the replacement of the air /c handler, outdoor condensing unit of a split system A/C or heat pump, cooling or heating coil, or the furnace heat exchanger) a refrigerant charge measurement shall be verified per §152 b 1 F. Central Fan Integrated (CFI) Ventilation System and Fan Watt Draw The ventilation requirements of §150 o do not apply to existing residential homes. Ducted Split Systems — Air Conditioners and Heat Pumps: Airflow — HERS verification is required for this measure. ❑ Yes No In Climate Zones 10 through 15, when the existing space -conditioning system (HVAC equipment and ducting) is replaced, the airflow and fan waft draw shall be verified per 152 b 1Ci to meet the recuirements of 151 7B. Documentation Author's Declaration Statement I certify that this Certificate of Compliance documentation is accurate and co Name: Signature. Company: Date: 4-k Address: City, State, Zip Code: DZ_S f Phone: Registration Number: Registration Date 8 Time: HERS Provider: 2008 Residential Compliance Forms PDAC January 2010 Installation Certificate ❑ Option 2: Measured leakage to outside less than 10% of Fan Airflow. CF-6R-MECH-2I-HERS Duct Leakage Test — Existing Duct System Determine nominal Fan Airflow using one of the following three calculation methods. Page 1 of 2 Site Address: //G A JJ p fM Enforcement Agency: >Permit Number: 0 Allowed leakage = Fan Airflow �6D x.15 CF,M./O 26�• /. 0 Enter the Duct System Name or Identification Number: t Enter the Duct System Location or Area Served: Pass if Actual Leakage is less than Allowed Leakage. NOTE: Submit one Installation Certificate for each ducts stem that must demonstrate compliance in the dwelling. n..�a � ....�....... ns........��:.. Tec♦ - Cviclinn 1'lnrf Cvc4nm Option 1: Measured leakage less than 15% of Fan Airflow. ❑ Option 2: Measured leakage to outside less than 10% of Fan Airflow. ❑ Option 3: Reduced leakage by 60% or more, and conduct smoke test to seal all accessible leaks. ❑ Option 4: Fix all accessible leaks using smoke test, and HERS rater must verify. Determine nominal Fan Airflow using one of the following three calculation methods. 'Cooling system method: Size of condenser in Tons c x 400 _ 16M v CFM. ❑ Heating system method: 21.7 x Heating Output Capacity (Btuh/k) = CFM. ❑ Measured system airflow using RA3.3 airflow test procedures: CFM. Option 1 used then: Allowed leakage = Fan Airflow �6D x.15 CF,M./O 26�• /. 0 1 Actual leakage = '32_ CFM + �� 6 Fan Airflow x 100 = ❑ .Pass Fail Pass if Actual Leakage is less than Allowed Leakage. Option 2 used then: Allowed leakage =fan Airflow X.10 = CFM. % 2 Actual leakage = CFM + Fan Airflow x 100,= ❑ Pass ❑ Fail Pass if Actual Leakage to outside is less than Allowed Leakage. Option 3 used then: Initial leakage prior to start of work: CFM. - Final leakage after sealing all accessible leaks using smoke test = DFM. O/O 3 Initial leakage - Final leakage = leakage reduction CFM. Leakage reduction + Initial leakage x 100 = ❑ Pass ❑ Fail Pass it % z 60%. Option 4 used then: 4 All accessible leaks repaired using smoke test. HERS rater must verify (no sampling). ❑Pass ❑Fail Pass if all accessible leaks have been sealed using S :Hoke Test. Registration Number: Registration Date & Time: 2008 Residential Compliance Forms HERS Provi&r: PDAC January 2010 Installation Certificate Responsible P son's Name: CF-6R-MECH-21-HERS Duct Leakage Test — Existing Duct System CSL�je_ns :3� Date Signed: /`� Position /Title: Page 2 of 2 Site Address: Enforcement Agency: Permit Number: HVAC Systems — HeatIng: Equipment Type Manufacturer Model Number AFUE HSPF Load Capacity Nil.€ ,v,. �^ y31(o i(/I 00 000 HVAC Systems — Coo lIng: _ Equipment Type Manufacturer Model Number �EE'� E Load Capacity Declaration Statement • 1 certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized representative of the person responsible for construction (responsible person). . • 1 certify that the installed features, materials, components, or manufactured devices identified on this certificate (the installation) conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the enforcement agency. • 1 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 ti -e 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. • 1 reviewed a copy of the Certificate of Compliance (CF -1 R) form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF -1 R 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 fo- all applicable inspections. 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: &I Responsible P son's Name: l f L d" LZ Respo to Person's S' nature: CSL�je_ns :3� Date Signed: /`� Position /Title: Is this installation monitored by a Third P rty Quality Control Program (TPQCP): - ❑ Yes No Name of TCQCP: Registration Number: Registration Date & Time: HERS Provider: 2008 Residential Compliance Forms PDAC January 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-21 Duct Leakage Test — Existing Duct System (Page 1 of 2) Site Address: Enforcement Agency: Permit Number: 54-865 Avenida Ramirez, La Quinta CA 92253 City of La Quin ta 10-288 Enter the Duct System Name or Identlfication/Tag: #1 Enter the Duct System Location or Area Served: Home 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 0 4. Fix all accessible leaks using smoke and HERS rater verify Note: (Option 1, 2 OR 3 must be attempted before utilizing Option 4) Determine nominal Fan Flow using one of the following three calculation methods. 2. Cooling system method: Size of condenser in Tons 4 x 400 = 1600 CFM ❑ Heating system method: 21.7 x _ Output Capacity in Thousands of Btu/hr = w CFM ✓ U Measured system airflow using RA3.3 airflow test procedures: _ CFM Option 1 used then: 1 Allowed leakage = Fan Flow 1600 x 0.15 = 240 CFM Actual Leakage = —299 CFM Pass if Leakage Actual is less than Allowed Pass ❑ Fail Option 2 used then: 2 Allowed leakage = Fan Flow 1600 x 0.10 = 160 CFM Actual Leakage to outside =, CFM Pass if Leakage Actual is less than Allowed rl Pass Fail Option 3 used then: Initial leakage prior to start of work= CFM ` Final leakage after sealing all accessible leaks using smoke test = CFM 3 , initial leakage _ - Final leakage _ = Leakage reduction CFM ((Leakage reduction / Initial leakage_) x 100% _ % Reduction _ Pass if % Reduction > 600% n Pass n 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 g Pass p Fail Reg: 110-A0005199A-000000000-:1131,4 Regisrrolion Dale/Time: 1010.104.30 15:21:46 HERSPRovider: CoICERTS 2008 Residential Compliance Forms Augusi 2009 L'd eSITi 0T 06 jdd CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING Duct Leakage Test - Existing Duct System Page 2 of 2) Site Address: Enforcement Agency: Permit Number: 54-865 Avenida Ramirez, La Quinta CA 92253 City of La Quinta 10-288 LTJ Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off during duct leakage testing. CFI OA ducts that utilize controlled motorized dampers, that oper 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. FJ All supply and return register boots 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 4 (fix al accessible leaks) described above. 0 New duct installations cannot utilize building cavities as plenums or platform returns in lieu :)f ducts, 9 Mastic and draw bands must be used in combination with cloth backed rubber adhesive duc- tape to seal leaks at all new duct connections DECLARATION STATEMENT I certify under penalty of perjury, under the laws of the state of California, the Information provided on this form is true and correct. I am the certified HERS rater who performed the verification services identified and reported on this certificate (respcnsible rater). The installed feature, material, component, or manufactured device requiring HERS verification that is identified on tF is certificate (the installation) complies with the applicable requirements to Reference Residential Appendices RA2 and RA3 and the regyirements 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 -61R), signed and submitted by th.! person(s) responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -1R) aporoved by the Builder or Installer information as shown on the Installation Certificate (CF -611) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) PALM DESERT AIR CONDITIONING CO INC Responsible Person's Name: CSLB License: Willim McCoy 374937 HERS Provider Data Registry Information - Sample Group # (if applicable): N/A 0 tested/verified dwelling ❑ not-tested/verfied dwelling in la HERS sample gaup HERS Rater Information CalCERTS Certificate # CCI -1798493157 HERS Rater Company Name: Air Experts Air Conditioning Responsible Rater's Name: Responsible Rater's Signature: Paul Van Vlymen Signature on File at CaICERTS, Inc. Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 4/28/2010 CC2004367 Reg: 210-A00p51994-000000000-.k,121A Registration DalalTime: 301010130 15:21:46 HERSPRavider: CaICERTS 2008 Residential Compliance Forms August 2009 6-d eST:Ti OT 06 jdd INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refri Brant Charge Verification - Standard Measurement Procedure (Page I of 5 Site Addr ss: Enforcement Agency: Permit Number: 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 MECff-25 Certificate) should be used to demonstrate compliance with the refrigerant charge verification requirement. TiVAH 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 ata additional forms) 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.Ifrefrige.-ant charge verification is required for compliance, TVA are also required for compliance. STMS are only required for completely new or replacement space -conditioning systems that utilize prescriptive compliance method. TM A t] A nw [.inane in Cunnly and RPtnrn Plenums of Air Handler System Name or identification/Tag System Location or Area Served sensor is factory installed, or field installed according to manufacturer's The sensor is factory installed, or field installed according to manufacturer's 3 ❑Yes EDNo 1 ['es ONO 5/16 inch (8 mm) access hole upstream of evaporative coil it the return plenum and labeled according to Figure in Section RA3.2.2.2.2. 2Yes [:]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 Fail I ✓ Pas ✓LjFail System Name or Identification/Tag sensor is factory installed, or field installed according to manufacturer's The sensor is factory installed, or field installed according to manufacturer's 3 ❑Yes EDNo specifications, or is installed by methods/specifications approved by the Executive Director. Director. The sensor wire is terminated 'tstandard mini plug suitable for connection to a The sensor wire is terminated with a standard mini plug suitable for connection to a 4 Oyes ONo digital thermometer. The sensor mini plug is accessible to the:installing technician and the HE r without changing the airflow through the condbnser coil the HERS rater without changing the airflow through the conclEnser coil 5 ❑Yes I [:]No The sensor measures the saturation tempera f the coil wit iin 1.3 degrees F Yes to 3, 4, and 5 is a pass. Enter ✓ NiA ✓ ❑ Pass ✓ []Fail N/A if STMS are not applicable. Otherwise enter Pass or Fail QTIkAQ Q-.._ __ +h- rnnal nncn� f nil System Name or identificationfTag sensor is factory installed, or field installed according to manufacturer's 6 []Yes �"The E140 specifications, or is installed by methods/specifications approved by the Executive Director. The sensor wire is terminated 'tstandard mini plug suitable for connection to a 7 �'es ❑No digital thermomet sensor mini plug is accessible to the:installing technician and the HE r without changing the airflow through the condbnser coil 8 ❑Yes QNo e sensor measures the saturation temperature of the coil witain 1.3 degrees F Yes to 6, 7, and 8is a Enter ✓ }p ✓ �p�s ✓ ❑Fail N/A if STMS are of applicable. Otherwise enter Pass or Fail LLS" Registration Number: Registration Date?ince: HERS Provider: 2008 Residential Compliance Forms .August 2009 6-d e9T:Tt OT OE -Jdd INSTALLATION CERTIFICATE, CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5 Site Address: IEnforcement Agency: Permit Number: 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 avai&ble in Reference Residential Appendix RA3.2. As many as 4 systems in the dwelling can be documented for compliance using t&is form. Attach an additional forms) for any additional systems in the dwelling as applicable. ' • The system should be installed and charged in accordance with the manufacturer's specifications before : tarring this procedure. • The system must meet minimum airflow requirements as prerequisite for a valid refrigerant charge rest. • If outdoor air dry-bulb is SS *For below, the installer must use the Alternate Charge Measurement Procedure. ace "-ununrwuu a.o,ua System Name or Identification/Tag t (must be ie -calibrated monthly) Date of Thermocouple Calibration � U System Location or Area Served Outdoor Unit Serial 4 -� Outdoor Unit Make AM -I VA Outdoor Unit Model / . .: •� Nominal Cooling Capacity Btu/hr IF Date of Verification ? —'2— Ll Date of Refrigerant Gauge Calibration y_ �, �(J (must be ie -calibrated monthly) Date of Thermocouple Calibration � U (must be ee-calibrated monthly) System Name or Identificadon/Tag Supply (evaporator leaving) air dry-bulb temperature (Tsu I , db) Return (evaporator entering) air dry-bulb temperature (Treturn, db) Return (evaporator entering) air wet -bulb temperature (Ti un,..w ) Evaporator saturation temperature t, Te •a orator, sal) . Condensor saturation temperature (Tconden r, at) Suction line temperature (Tsuction) Liquid Line Temperature (Ttiquid) Condenser (entering) air dry-bulb r F� temperature (Tcondenser. db) Registration Number: 2008 Residential Compliance Forms ol*d Registration DateiTime: HER'3 Provider: Augusi 2009 e9T r I i oT DE -tdd INSTALLATION CERTIFICATE CF-15R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5' Site Address: Enforcement Agcncy: Permit Number: Temperature Split Method Calculations for determining Minimum Airflow Requirement for Refrigerant Charge Verification. The temperature split method is specified in Reference Residential Appendix RA3.2.. System Name or Identification/Tag Calculate: Actual Temperature Split = Tretum• db - Tsuppl�-, db Z Target Temperature Split from Table Tretum, Tretum> RA3.2-3 using wb and db t Calculate difference: Actual Temperature = Split — Target Temperature Split Passes if difference is between -3°F and +3°F or, upon remeasurement, if between -3°F and -100°F Enter Pass or Fail S A'ote: Temperature Split Method Calculation is not necessary if actual Cooling Coil Airflow is yerftted using one of the airflow measurement procedures specified in Reference Residential Appendix RA3.3. If actual cooing coil airflow is measured, the value must be equal to or greater than the Calculated Minimum Airflow Requirement in rhe table below. Calculated Minimum Airflow Requirement (CFM) = Nominal Cooling Capacity (ton) X 3W (cfm/ton) System Name or Identification/Tag Calculated Minimum Airflow Requirement (CFM) Measured Airflow using RA3.3 procedures (CFM) Passes if measured airflow is greater than or equal to the calculated minimum airflow requirement. EnterP r Fail Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedures requir a used for fixed orifice metering device systems - System Name or Identification/Tag Calculate: Actual Superheat = Tsucti n—Teva orator, sat Target Superheat from Table RA3.2-2 using Tretum, wb and Tconden er, db Calculate difference: Actual Superheat —Tar et Su er = System passes if different etween -5°F and +5°F nter Pass or Fail Registration :Number.• 2008 Residential Compliance Forms TT - d Registration Daie/Time: HERZ' Provider.• August 2009 eLT s T 1 0T OE -Add INSTALLATION CERTIFICATE CF=611-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure OR e 4 of 5 Site Address: Enforcement Agency: Pcrttit Number: Subcooling Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag Calculate: Actual Subcooling = Tecndenser. sat — Tli uid Target Subcooling specified by manufacturer 23 Calculate difference: Actual Subcooling — Target Subcooling= System passes if difference is between .3°F and +3°F Enter Pass or Fail Pass r Metering Device Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag Calculate: Actual Superheat Tsuction — Teva orator sat Enter allowable superheat range from manufacturer's specifications (or use range between 4°F and 25°F if manufacturer's 23 specification is not available System passes if actual superheat is within the allowable superheat range Enter Pass or Fail Registration Number: Registration DatelTime: HER.; Provider: 2008 Residential Compliance Forms ,August 1009 21'd eLTtil OT OC -tdH INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5 Site Address: Enforcement Agency: Perrr.it Number: Standard Charge Measurement Summary: System shall pass both refrigerant charge criteria, metering device criteria (if applicable), and mirimum cooling coil airflow criteria based on measurements taken concurrently during system operation. If corrective -actions were taken, all aoalicable verification criteria must be re -measured and/or recalculated. System Name or IdentificationiTag System meets all refrigerant charge and airflow requirements. Enter Pass or Fail DECLARATION STATEMENT • 1 certify under penalty orperjury, under the laws of the State of California, the information provided on this form is true and correct. • 1 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 cerci icate (the installation) conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the enforcement agency. • 1 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 providt:r representatives will also perform quality assurance checking of installations, including those approved as part of sample group but not checked by a HERS rater, and if those installations fail to meet the requirements of such quality assurance checking, the requir:d corrective action and additional checking/testing of other installations in that HERS sample group will be performed at my expanse. • I reviewed a copy of the Certificate of Compliance (CF -1R) form approved by the enforcement agency thst identifies the specific requirements for the installation. 1 certify that the requirements detailed on the CF -IR 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 a-ailable 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 Cor. multiple orientation alternatives, and beginning October I, 2010, for all low-rise residential buildings. Co any Name: (Installing Subcontractor or General Contractor or Builder/Owner) 7�*_w\ DES RT Ar t jL Pei /D i� ut_ ' Responsible Person's Name: Responsible Person's Signature: ' CSLB License: Date Signed: Position With Company (Title): 3 4� 37 -Z�- � e- L; Is this installation monitored by a Third Part Quality C ntr I Name of TPQCP (if applicable): Program (TPQCP)? (TPQCP)? ]Yes o Registration Number: Registration Dole,Time: HERa Provider: 2008 Residential Compliance Forms Augusi 2009 ET 'd eeT : T T of OE -idd CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure • jPage 1 of 5) Site Address: Enforcement Agency: Permit Number: 54-865 Avenida Ramirez, La Quinta CA 92253 City of La Quinta 10-288 Note: If installation of a Charge Indicator Display (CID) is utilized as an alternative to refrigerant charge verincation for compliance, a MECH-24 Certificate (instead of this MECH-25 Certificate) should be used to demonstrate co.pliance with the refrigerant charge verification requirement. TMAH and 5TMS are not required for compliance, when a CTD is utilized for compliance. As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additicnal 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 verincation is required for compliance, TMAH are also required for compliance. STMS are only required for, completely fie v or replacement space -conditioning systems that utilize prescriptive compliance method. _J n..r....w nlew.....� -W Air %4 n 411ar System Name or Identlf9cation/ rag #1 System Location or Area Served 1 Yes No Home 5/16 inch (8mm) access hole upstream of evaporative coil In the rets+rn plenum and labeled according to Figure in Section RA3.2.2.2.2. 2 _l Yes' D 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 Fail ✓ G Pass ✓ ❑ Fail System Name or Identification/Tag System The sensor is factory installed, or field installed according to manufaeurer's 3 ❑ Yes C No specifications, or is installed by methods/specifications approved by tie Executive Director. The sensor wire is terminated with a standard mini plug suitable for Connection to a 4 ❑ Yes O 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 The sensor measures the saturation temperature of the coil within 1.3 degrees F Yes to 3, 4, and 5 is a pass. Enter N/A if STMS are not 0 N/A ✓ ❑Pass ✓ ❑Fail applicable. Otherwise enter Pass or Fail CTUG _ Gewc,.- wn rhe r..wao.,�e� rna System Name or Identification/Tag System The sensor is factory installed, or field installed according to manufaczurer's 6 ] Yes -D No specifications, or is installed by methods/specifications approved by tie 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 U Yes I U No IThe sensor measures the saturation temperature of the coil within 1.7 degrees F Yes to 3, 4, and 5 is a pass. Enter N/A if STMS are not V ❑ N/A ✓ ❑ Pass ✓ ❑ Fail applicable. Otherwise enter Pass or Fail Reg: 210-A0005199A-000000000-,bf25A Registration Date'Time: 2010!04/3075: 25:47 HERSPRovider. CCAICERTS 2008 Residential Compliance Forms August 2009 -d eETII OT 06 add CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4111-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5) Site Address: Enforcement Agency: Permit Number: 54-865 Avenida Ramirez, La Quinta CA 92253 City cf La Quinta 10-288 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 add tional 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 starling 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. System Name or Identification/Tag 4/5/10 (must be re -calibrated monthly) Date of Thermocouple Calibration 4/5/10 System Location or Area Served Home Outdoor Unit Serial fl 1002662147 Outdoor Unit Make Amana Outdoor Unit Model AS21404AD Nominal Cooling Capacity Btu/hr 48000 Date of Verification 4/28/10 Date of Refrigerant Gauge Calibration 4/5/10 (must be re -calibrated monthly) Date of Thermocouple Calibration 4/5/10 (must be re -calibrated monthly). System Name or Identification/Tag #1 Supply (evaporator leaving) air dry-bulb 50 temperature (Tsupply, db) Return (evaporator entering) air dry-bulb 76 temperature (Tretum, db) Return (evaporator entering) air wet -bulb 65 temperature (Treturn, wb) Evaporator saturation temperature 40 (Tevaporator, sat) Condensor saturation temperature 91 (Tcondensor, sat) Suction line temperature (Tsuction) 63 Liquid Line Temperature (Tliquid) 82 Condenser (entering) air dry-bulb temperature (Tcondenser, db) Reg: 210-A0005199A-000000000-942SA Registration DaieiTime: 2010/04/30 15:25:47 HERSPRocider CaICERTS 2008 Residential Compliance Forms August 2009 E•d eCI:TT 0T 06 .,dd INSTALLATION CERTIFICATE CF-4111-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5) Site Address: EnforcementAgency: Permit Number: 54-865 Avenida Ramirez, La Quinta CA 92253 City of La Quinta 10-288 l:.i�—... www..: r.�.wa.w• 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 #1 w Calculate: Actual Temperature Split = Treturn, db 26 - Tsupply, db Target Temperature Split from Table RA3.2-3 24 using Treturn, wb and Treturn, db Calculate difference. Actual Temperature Split - 2 Target Temperature Split = Passes if difference is between -4°F and +4°F or, upon remeasurement, if between -4°F and -100°F PASS Enter Pass or Fail Note: Temperature Split Method Calculation is not necessary if actual Cooling Coil Airflow is verified usinc one of the airflow measurement procedures specified in Reference Residential Appendix RA3.3. If actual cooling coifairflow is measured, the value must be equal to or greater than the Calculated Minimum Airflow Requirement in the table below. Calculated Minimum Airflow Requirement (CFM) = Nominal Cooling Capacity (ton) X 300 (dm:ton) System Name or Identification/Tag Calculated Minimum Airflow Requirement (CFM) Measured Airflow using RA3.3 procedures (CFM) Passes if measured airflow Is greater than or equal to the calculated minimum airflow requirement. Enter Pass or Fail Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for fixed orifice metering device systems i System Name or Identification/Tag w 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 -61F and +6°F Enter Pass or Fail Reg:2l0-A0005199A-000000000-,t125A RegistrationDalelTime:201010413015:25:47 HERSPRovider:Ca10ERTS' 2008 Residential Compliance Forms August 2009 �d etT:TT OT 06 -jdd INSTALLATION CERTIFICATE C=-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5) Site Address:Enforcement Agency: " Permit Ntmber: 54-865 Avenida Ramirez, La Quinta CA 92253 City of La Quinta 10-288 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 #1 Calculate: Actual Subcooling = 9 23 Tcondenser, sat - Tliquid - Tsuction - Tevaporator, sat Target Subcooling specified by manufacturer 9 Enter allowable superheat range from Calculate difference: , 0 I Actual Subcooling - Target Subcooling = 23 System passes if difference is between between 3°F and Z6°F if manufacturer's -4°F and ''+41F PASS specification is not available) Enter Pass or Fail System passes if actual superheat is within the 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 identificationrrag 91 Calculate: Actual Superheat = 23 - Tsuction - Tevaporator, sat Enter allowable superheat range from I manufacturer's specifications (or use range 23 between 3°F and Z6°F if manufacturer's specification is not available) System passes if actual superheat is within the iallowable superheat range PASS Enter Pass or Fail Reg: 210-A0005199A•000000000,W25A RegistrationDate/Timc: 2010,'01/3015:25:37 HERSPRovider: Ca1CkRI3 2008 Residential Compliance Forms August 2009 S'd et,ITT 0T 0C.Jdd r INSTALLATION CERTIFICATE C,=-411-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of S) Site Address: Enforcement Agency. Permit NL mber: 54-865 Avenida Ramirez, La Quinta CA 92253 City of La Quinta 10-288 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 actionE were taken, all applicable verification criteria must be re -measured and/or recalculated. System Name or Identification/Tag #1 374937 HERS Provider Data Registry Information Sample Group # (if applicable): N/A Q tested/verified dwelling System meets all refrigerant charge and airflow, a HERS sample groupHERS Rater Information CaICERTS Certificate # CC1-1798493157 HERS Rater Company Name: requirements. PASS Responsible Rater's Signature: Paul Van Vlymen Signature on File at Ca10ERTS, Inc. Enter Pass or Fail Date Signed: 4/28/2010 CC2004367 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 tfe person(s) responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -LR) 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) PALM DESERT AIR CONDITIONING CO INC Responsible Person's Name: CSLB License: Willirrf McCoy 374937 HERS Provider Data Registry Information Sample Group # (if applicable): N/A Q tested/verified dwelling 0 not=tested/venfred d -wiling in a HERS sample groupHERS Rater Information CaICERTS Certificate # CC1-1798493157 HERS Rater Company Name: Air Experts Air Conditioning Responsible Rater's Name: Responsible Rater's Signature: Paul Van Vlymen Signature on File at Ca10ERTS, Inc. Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 4/28/2010 CC2004367 r Reg: 210-0005199A-000000000.M25A Registration Dafe.Time: 20101'04%30 15:25:47 HERSPRovider CaIC£RTS 2008 Residential Compliance Forms Augusi 2009 9-d eSI=II 01 06 .add