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10-0877 (MECH)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: � 10-00000877 Property Address: 45070 BRIDGETTE WY APN: 604-311-007-7 -26188 - Application description: MECHANICAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 11959 Tiht 4 4v Q" Applicant: Architect or Engineer: cJ 4/-,/ - Alg-- ----------------- LICENSED CONTRACTOR'S DECLARATION BUILDING & SAFETY DEPARTMENT BUILDING PERMIT 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 I License No.: 686310 Date Contractor: A 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 ($500).: 1 _ I I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build,or improve for the purpose of sale.). (_) . I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractorls) licensed pursuant to the Contractors' State License Law.). I _) I am exempt under Sec. , B.&P.C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: _ Lender's Address: LQPERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 D� Dag: 9/ _10 Owner: SEILER LEROY n`� �$ 45070 BRIDGETT WAY J 2010 LA QUINTA, CA 92253 ( CITY OF�AQDIMTA FINANCE DEPT: Contractor: GENERAL AIR CONDITIONING 31170 RESERVE DRIVE THOUSAND PALMS, CA 92276 (760)343-7488 Lic. No.: 686310 ------------------ 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 PREFERRED EMPL Policy Number WKN1295355 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 a ,/0[)of the Labor Code, I shall for with comply with those provisions. Date VApplicant: - WAR ING: FAILURE TO SECURE WO ERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS 1$100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. 1 . Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application, the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the 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 in thiss u y t enter upon the above-mentioned property for inspection purposes. /— Date: ` O Signature (Applicant or Agent): /,�/ V t17 Application Number . . . . 10-00000877 Permit . . . MECHANICAL Additional desc . Permit Fee . . . . 33.00 Plan Check Fee 8.25 Issue Date . . . . Valuation . . . . 0 Expiration Date 3/07/11 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 HVAC CHANGE OUT 4 TON SYSTEM - UPFLOW - GROUND 13 SEER. 2007 CODES. ---------------7------------------------------------------------------------ Other Fees . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged --------------------------- ---------- Paid Credited -=------------------ Due Permit Fee Total 33.00 .00 .00 33.00 Plan Check Total 8.25 .00 .00 8.25 Other Fee Total 1.00 ..00 .00 1.00 Grand Total 42.25 .00 .00 42.25 LQPERMTT Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -IR -ALT -HVAC Climate Zones 10 to 15 Sit Address: \ En orceme Agen ,y: ` Date: Permit Condi toned Floor Equipment T e' List Minimum Efficiency' Duct insulation requirement Area Thermostat ❑ Packaged Unit CFT-umace ❑ AFUE150 ❑ COP Over 40 ft of ducts added orck �Sleor Coil ❑SEER ❑ HSPF replaced in unconditioned space ❑ R 6 (CZ 10-13) Served by system sf (Ijnotalready present, must be Q,Condensing Unit ❑ EER ❑Resistance ❑ Other ❑ R 8 (CZ 14-15) installed) 1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -1 R ALT -HVAC for each system. 2. Minimum Equipment Efficiencies: 13 SEER, 78%AFUE, 7.7HSPFfor typical residential systems. HERS VERIFICATION SUNUM[ARY Listed below are four HVAC alteration Options. The installer decides what work is being done and picks one of the appropriate Options. Each Option lists the HERS measures that must be conducted. A copy of the forms shall be left on site for final inspection and a copy given to the homeowner. At final, the inspector verifies that the work listed on this form was in fact the work completed by the installer. The inspector also verifies that each appropriate CF -6R and registered CF -4R forms (no hand filled CF-4Rs allowed) are filled out and signed._JMg-inning October 1 2010, a registered copy of the CF -1R and CF -6R shall also be on site for final inspection. HVAC Changeout Required Forms: • All HVAC Equipment replaced CF-6Rforms: MECH-04, MECH-2I-HERS and (for split systems) MECH- 25 -HERS CF-411forms: MECH- 21 and fors lit stems MECH-25 • Condenser Coil and/or • Indoor Coil and/or CF -6R forms: MECH-2I-HERS and (for split systems) MECH- 25 -HERS CF -4R forms: MECH- 21 and (for split systems) MECH-25 • Furnace For Split Systems: Duct leakage < 15 percent; RC, CCA >_ 300 CFM/ton(Minimum Air Flow Requirement), TMAH For Packaged Units: Duct leakage < 15 percent Exempted from duct leakage testing if ❑ I. Duct system was documented to have been previously sealed and confirmed through HERS verification, or ❑ 2. Duct systems with less than 40 linear feet in unconditioned space, or ❑ 3. Existing ducts stems are constructed, insulated or sealed with asbestos ❑ 2. New HVAC System Required Forms: • Cut in or Changeout with new ducts: (all new ducting and all CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS CF -4R forms: MECH 20-, and (for split systems)MECH-22, and MECH 25 new equipment) For Split Systems: Duct leakage < 6 percent; RC, CCA >_ 350 CFM/ton, FWD, TMAH, STMS, and either HSPP or PSPP. For Packaged Units: Duct leakage < 6 percent 0.3. New Ducts with Replacement Required Forms: • Includes replacing or installing all new ducting CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-25-HERS and/or outdoor condensing unit and/or indoor CF -411 forms: MECH-20 and (for split systems) MECH-25 coil and/or furnace. Not all equipment changed. For Split Systems: Duct leakage < 6 percent, RC, CCA > 300 CFM/ton, TMAH For Packaged Units: Duct leakage < 6 percent ❑ 4. New Ducting over 40 feet Required Forms: • Includes adding or replacing more than 40 CF -6R forms: MECH-04, MECH-2I-HERS CF -4R forms: MECH-21 linear feet of duct in unconditioned space. For split system or packaged units: Duct leakage < 15 percent ❑ EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos. Contractor (Documentation Author's /Responsible Designer's Declaration Statement) • I certify that this Certificate of Compliance documentation is accurate and complete. • I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of Compliance. • I certify that the energy features and performance specifications for the design identified on thi's Certificate of Compliance conform to the requirements of Title 24, Parts 1 and 6 of the California Code of Regulations. • The design features identified on this Certificate of Compliance are consistent with the information docume d on other applicable compliance forms, worksheets, calculate ns, plans andspecifications submitted to the enforcement agency for approval with the permit apiflicdtion. Name: Signature: Company: �i 000 Date: 1 Address: 1 � O U n � � ` j/ License: b 1(f City/State/Zip: Phone: Din f qty of La QuInia "Building U Safety DMslon P.O. Box 1504, 78-495 Calle Tampico La Qulnta, CA 92253 - (760) 777-7012 ' Building Permit-Application and. Tracking Sheet i Owners Name: Z �l Permit # G Project Address: A. P. Number: ". Address: _ r I Legal Description: City, ST, Zip: J 1 /� C S Contractor:CQ Address: .,� ...,. ".... ww Project Description: City, ST, Zip: 7d(-)Q05-C44 Wks, a ,1 Telephone: 3kqlsfs:::.;..• .>:::: :,, :" .�.;w.:`'. %Y `,'•': ;'':}'url.•,'%•'.?: f.:4w{�^{ate State Lie. # : 3 City Lie. �.. . Arch., Engr., Designer: i �` Address: City., ST, Zip: Telephone:'.3? fi �'. <...„ w€`•'h acv?'. <..::,:k' State Lie. #:si<<f3€'t Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo Sq. Ft.: # St ries: #Units: Name of Contact Person: Telephone # of Contact Person: Estimated Value of Project. APPLICANT: DO. NOT WRITE. BELOW THIS LINE # Submittal Req'd" Recd TRACEJNG PERMIT FEES Plan Sets" Plan Check submitted Item Amount Structural Cafes. Reviewed, ready for corrections Plan Check Deposit Truss Cafes. Called Contact Person Plan Check Balance Title 24 Calcs. Plans picked up Construction " Flood plain plan Plans resubmitted Mechanical Grading plan 2"d 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:- 7rd 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 ` 6�g (--/ CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-21 Duct Leakage Test - Existing Duct System (Page 1 of 2) Site Address: 45070 BRIDGETT WAY, La Quinta CA 92253 (System Enforcement Agency: Permit Number: 1) City of La Quinta 10-877 Enter the Duct System Name or Identification/Tag: Enter the Duct System Location or Area Served: Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the dwelling. This installation certificate is required for compliance for alterations and additions in existing dwellings to space conditioning systems and duct systems. Note: For existing dwellings, a completely new or replacement duct system can also include existing parts of the original duct system (e.g., register boots, air handler, coil, plenums, etc.) if those parts are accessible and they can be sealed. For a completely new or replacement duct system installed in an existing dwelling, use the Installation Certificate titled "Duct Leakage Test - Completely New or Replacement Duct System. " Duct Leakage Diagnostic Test - existing duct system Select one compliance method from the following four choices. O 1. Measured leakage less than 15% of fan flow ❑ 2. Measured leakage to outside less than 10% of Fan Flow ❑ 3. Reduce leakage by.60% and conduct smoke and fix all leaks ❑ 4. Fix all accessible leaks using smoke and HERS rater verify 3 5 Note: (One of Options,_l, 2, or 3 mu sty be.attemptedwbefore„utilizing Option.4 Determine riominal"Fan Flow using one of.th6 following three calculation methods • ✓ ❑ Cooling,system method: Size of condenser in Tons I x:4106. 'CFM,,` '- ✓ ❑ Heatin system meth 21.7 x + Out ut capacityin Thousands of. Btu hr = - CFM111— ,� i' ✓ ❑ Measured-sy_stem airflow, using W3airflow.Ptest proce.,.dures ;_CFM Option 1 used then: " 1 Allowed leakage = Fan Flow_! x 0.15 = _CFM Act_ual,Leakage-== CFM Pass if Leakage Actual is less than Allowed ❑ Pass ❑ Fail 2 Option 2 used then:' Allowed leakage = Fan'Flow_ x 0.10 = _ CFM Actual Leakage to outside ` ?_ CFM Pass if Leakage Actual is less than Allowed ❑ Pass ❑ Fail Option 3 used then: Initial leakage prior to start of work = _ CFM Final leakage after sealing all accessible leaks using smoke test = _ CFM 3 Initial leakage_ - Final leakage _ = Leakage reduction _ CFM ((Leakage reduction _/ Initial leakage x 100% _ % Reduction Pass if % Reduction > 60% E] Pass E3 Fail Option 4 used then: 4 All accessible leaks repaired using smoke. HERS rater must verify (No sampling). No smoke allowed to leak from system. Including ducts, plenums, air handler and door panel. Pass if all accessible leaks have been repaired using smoke ❑ Pass Fail Reg: 210-A0028650A-M2100001A-M21A Registration Date/Time: 2010/12/03 18:24:20 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-21 Duct Leakage Test — Existing Duct System (Page 2 of 2) Site Address: 45070 BRIDGETT WAY, La Quinta CA 92253 (System Enforcement Agency: Permit Number: 1) City of La Quinta 10-877 i ❑ Outside air (OA)fducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off during duct leakage testing. CFI!,OA ducts that utilize controlled motorized dampers, that open only when OA ventilation is required to meet ASH RAE, Standard .62.2, -and close -_when_OAjventilation,is not -required, may be confi ured`to the closed osition du�in9 duct leaks e,testing � g P g ❑ All supply and returyeglste boots must be sealed to,the dr If smoke#test is utilized for compliance`- , .- - applies to duct leakage compliance option 3 (leakage'reduction by'60%)nd option 4_(fix all accesslble1 leaks) described above.F� � ❑ New duct installations tions cannotutilize building cavities ash P plenums or platform returns in lieu ofl du. t F I ❑ Mastic .anclclraWbancls must be used in combination with cloth backed rubber adhesive duct tape to seal leak's at all new duct connections DECLARATION STATEMENT • I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. • I am the certified HERS rater who performed the verification services identified and reported on this certificate (responsible rater). • The installed feature, material, component, or manufactured device requiring HERS verification that is identified on this certificate (the installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified on the Certificate(s) of Compliance (CF -1R) approved by the local enforcement agency. • The information reported on applicable sections of the Installation Certificate(s) (CF -6R), signed and submitted by the person(s) responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -1R) approved by the enforcement agency. Builder or Installer information as shown on the Installation Certificate (CF -611) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) HARRISON ENTERPRISES INC Responsible Person's Name: CSLB License: Danielle Garcia 1686310 HERS Provider Data Registry Information Sample Group # (if applicable): 181887 ❑ tested/verified dwelling not-tested/verified dwelling in la HERS sample group HERS Rater Information CalCERTS Certificate # CC1-1798525897 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: 11/16/2010 CC2004131 Reg: 210-A0028650A-M2100001A-M21A Registration Date/Time: 2010/12/03 18:24:20 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4111-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 5) Site Address: Enforcement Agency: Permit Number: 45070 BRIDGETT WAY, La Quinta CA 92253 City of La Quinta 10-877 Note: If installation of a Charge Indicator Display (CID) is utilized as an alternative to refrigerant charge verification for compliance, a MECH-24 Certificate (instead of this MECH-25 Certificate) should be used to demonstrate compliance with the refrigerant charge verification requirement. TMAH and STMS are not required for compliance, when a CID is utilized for compliance. As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional form(s) for any additional systems in the dwelling as applicable. Temperature Measurement Access Holes (TMAH) and Saturation Temperature Measurement Sensors (STMS) Procedures for installing TMAH are specified in Reference Residential Appendix RA3.2. If refrigerant charge verification is required for compliance, TMAH are also required for compliance. STMS are only required for completely new or replacement space -conditioning systems that utilize prescriptive compliance method. TMAH - Access Holes in Supply and Return Plenums of Air Handler System Name or Identification/Tag T. .Jifr '"•" System Location or Area Served 1 ❑ Yes ❑ No5/16 , inch (8 mm) access hole upstream of evaporative coil in the return plenum and labeled according to Figure in Section RA3.2.2.2.2. 2 ❑ Yes ❑ No 5/16 inch (8 mm) access hole downstream of evaporative coil in the supply plenum and labeled according to Figure in Section RA3.2.2.2.2. Yes to•l.and.2 is a pass. Enter Pass or Fail ✓ ❑ Pass I ✓ ❑ Fail STMS'- Sensor on Ethel Evaporator Coil System Name'or Identification/Tag') T. .Jifr '"•" . The sensor is factory installed, oryfield.instalied according to manufacturer.'s W 3 ❑ Yes p.No �;] specifications, or is°installed by method`s/specifications approved by the Executive :a Director. Director. Ia'�- % ���,,,g ` The sensor wire is terminated with a standard mini plug suitable for connection to a The sensorr.wire is terminated.with a standard mini plug suitable for connection.;to a, 4 ElYes .. El No digital thermometer. The'ssensor mini plug.is accessible to'the installing,tect nician Q.. ` and the HERS rater without changing the airflow through the condenser coil and the HERS rater without changing the airflow through the condenser coil 5 ❑ Yes--t-dsaturation ❑ NO When attached to a digital thermometer, the sensor provides an indication of the saturation temperature of the coil. temperature of the coil. 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 STMS - Sensor on the Condenser Coil System Name or Identification/Tag The sensor is factory installed, or field installed according to manufacturer's 6 ❑ Yes ❑ No specifications, or is installed by methods/specifications approved by the Executive Director. The sensor wire is terminated with a standard mini plug suitable for connection to a 7 ❑ Yes ❑ No digital thermometer. The sensor mini plug is accessible to the installing technician and the HERS rater without changing the airflow through the condenser coil 8 ❑ Yes ❑ No When attached to a digital thermometer, the sensor provides an indication of the saturation temperature of the coil. Yes to 6, 7, and 8 is a pass. Enter N/A if STMS are not ✓ CEJ N/A ✓ ❑Pass ✓ ❑Fail applicable. Otherwise enter Pass or Fail Reg: 210-A0028650A-M2500001A-M25A Registration Date/Time: 2010/12/03 18:25:13 HERS Provider: CalCERTS, 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: 45070 BRIDGETT WAY, La Quinta CA 92253 City of La Quinta 10-877 Standard Charge Measurement Procedure (for use if outdoor air dry-bulb is above 55°F) Procedures for determining Refrigerant Charge using the Standard Charge Measurement Procedure are available in Reference Residential Appendix RA3.2. As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional form(s) for any additional systems in the dwelling as applicable. • The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure. • The system must meet minimum airflow requirements as prerequisite for a valid refrigerant charge test. • If outdoor air dry-bulb is 55°F or below, the installer must use the Alternate Charge Measurement Procedure. Space Conditioning Systems System Name or Identification/Tag (must.be re -calibrated monthly) .. System Location or Area Served P Date of Thermocoupls���erCalibration ` -(!must be re calibrated monthly) Outdoor Unit Serial # Outdoor Unit Make a Outdoor Unit Model Nominal Cooling Capacity Btu/hr Date of Verification canoration or wagnostic Instruments Date of Refrigerant Gauge Calibration (must.be re -calibrated monthly) .. •, P Date of Thermocoupls���erCalibration ` -(!must be re calibrated monthly) Supply (evaporator leaving) -air dry-bulb"'" Measurea-[temperatures-("1-.,j f, System Name or Ident ficahon/T gf:: -- Supply (evaporator leaving) -air dry-bulb"'" temperature (Tsupply, db) : a Return (evaporator'entering) air dry-bulb tempeFature (Treturn, db). Return (evaporator entering) air wet -bulb temperature (Treturn, wb) `"' , I Evaporator saturation temperature (Tevaporator, sat) Condensor saturation temperature (Tcondensor, sat) Suction line temperature (Tsuction) Liquid Line Temperature (Tliquid) Condenser (entering) air dry-bulb temperature (Tcondenser, db) Reg: 210-A0028650A-M2500001A-M25A 2008 Residential Compliance Forms Registration Date/Time: 2010/12/03 18:25:13 A HERS Provider: CalCERTS, Inc. March 2010 INSTALLATION CERTIFICATE CF-411-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5) Site Address: Enforcement Agency: Permit Number: 45070 BRIDGETT WAY, La Quinta CA 92253 City of La Quinta 10-877 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. 4 l 1 Calculated Minimum Airflow Requirement (CFM) = Nominal Cooling Capacity (ton) X 300 (cfm/ton) �R System, Name, or Identification/Tag 41. -7 Calculated Minimum ;eer Airflo'w"Rqt r + r - '- -- f w Measured Airflow using RA3 3 procedures (CFM) Passes if measured airflow is greater than or equal' to the calculated minimum airflow requirement. -p -t Enter Pass or Fail ,1 1 Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for fixed orifice metering device systems System Name or Identification/tag Calculate: Actual Superheat = Tsuction - Tevaporator, sat Target Superheat from Table RA3.2-2 using Treturn, wb and Tcondenser, db Calculate difference: Actual Superheat - Target Superheat = System passes if difference is between -6°F and +6°F Enter Pass or Fail 11 Reg: 210-A0028650A-M2500001A-M25P_ Registration Date/Time: 2010/12/03 18:25:13 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms, March 2010 INSTALLATION CERTIFICATE CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5) Site Address: Enforcement Agency: Permit Number: 45070 BRIDGETT WAY, La Quinta CA 92253 City of La Quinta 10-877 Subcooling Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag Calculate: Actual Subcooling = Tcondenser, sat - Tliquid Target Subcooling specified by manufacturer Calculate difference: Actual Subcooling - Target Subcooling = System passes if difference is between I 1:9-, -4°F and +4°F ' a a Enter Pass or Fail l` T Metering Device Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag Calculate: Actual Superheat = t Tsuction - Tevaporator, sat Enter allowable superheat range from manufacturer's specifications (or use range between 3°F and 26°F if manufacturer's specification is not,ayailable) 1 M. — _I I 1:9-, Systempassesif actual superheat is'within'the - ' a a allowable superheat range / 'Ent l` T Pass or Fail ,�- Reg: 210-A0028650A-M2500001A-M25A Registration Date/Time: 2010/12/03 18:25:13 HERS Provider: CalCERTS, inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5) Site Address: Enforcement Agency: Permit Number: 45070 BRIDGETT WAY, La Quinta CA 92253 City of La Quinta 10-877 Standard Charge Measurement Summary: System shall pass both refrigerant charge criteria, metering device criteria (if applicable), and minimum cooling coil airflow criteria based on measurements taken concurrently during system operation. If corrective actions were taken, all applicable verification criteria must be re -measured and/or recalculated. System Name or Identification/Tag Danielle Garcia 1686310 HERS Provider Data Registry Information Sample Group # (if applicable): 181887 System meets all refrigerant charge. and airflow not-tested/verified dwelling in la HERS sample group requirements. HERS Rater Company Name: Energy Driven Solutions, Inc. Responsible Rater's Name: Responsible Rater's Signature: Enter Pass or Fail David Bricker Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 11/16/2010 CC2004131 r i i a i s -, f i DECLARATION STATEMENT I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. .. I am 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 -IR) approved by the local enforcement agency. The information reported on applicable sections of the Installation Certificate(s) (CF -611), signed and submitted by the person(s) responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -1R) approved by the enforcement agency. Builder or Installer information as shown on the Installation Certificate (CF -6R) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) HARRISON ENTERPRISES INC Responsible Person's Name: CSLB License: Danielle Garcia 1686310 HERS Provider Data Registry Information Sample Group # (if applicable): 181887 ❑ tested/verified dwelling not-tested/verified dwelling in la HERS sample group HERS Rater Information CaICERTS Certificate # CCi-1798525897 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: 11/16/2010 CC2004131 Reg: 210-A0028650A-M2500001A-M25A Registration Date/Time: 2010/12/03 18:25:13 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 �Prmt„•',;� �;Subm�t�,� �, Res�ett���, c,"�.S vie, A a; Enter the Duct System Name or Identification/Tag: Enter the Duct System Location or Area Served: Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the dwelling. This installation certificate is required for compliance for alterations and additions in existing dwellings to space conditioning systems and duct systems. Note: For existing dwellings, a completely new or replacement duct system can also include existing parts of the original duct system (e.g., register boots, air handler, coil, plenums, etc) if those parts are accessible and they can be sealed. For a completely new or replacement duct system installed in an existing dwelling, use the Installation Certificate titled "Duct Leakage Test — Completely New or Replacement Duct System. " Duct Leakage Diagnostic Test — Existing Duct System Select one compliance method from the following four choices. Option 1. Measured leakage less than 15% of Fan Airflow. 13 Option 2. Measured leakage to outside less than 10% of Fan Airflow. 0 Option 3. Reduce leakage by 60% or more, and conduct smoke test to seal all accessible leaks. 0 Option 4. Fix all accessible leaks using smoke test, and HERS rater must verify. Note: (Option I must be attempted before utilizing Option 4) Determine nominal Fan Airflow using one of the following three calculation methods. WCooling system method: Size of condenser in Tons —4'61 x 4.00 = a 0 CFM E3 Heating system method: 21.7 x Heating Output Capacity (kBtuh) = CFM G Measured system airflow using RA3.3 airflow test procedures: CFM. Option 1 used then: Allowed leakage = Fan Airflow �b �© x 0.15 CFM 1 Actual leakage CFM Pass if Actual leakage is less than Allowed leakage W"Oass [3 Fail Option 2 used then: Allowed leakage = Fan Airflow x 0.10 = CFM 2 Actual leakage to outside = CFM Pass if Actual leakage to outside is less than Allowed leakage 0 Pass 13 Fail Option 3 used then: Initial leakage prior to start of work= 365— CFM Final leakage after sealing all accessible leaks using smoke test = CFM 3 Initial leakage - Final leakage = Leakage reduction CFM (Leakage reduction / Initial leakage ) x 100% = % Reduction Pass if % Reduction > 60% ® Pass ® Fail Option 4 used then: All accessible leaks repaired using smoke test. HERS rater must verify (No sampling). 4 Pass if all accessible leaks have been sealed using Smoke Test [3 Pass A Fail Registration Number: Registration Date/Time: HERS Provider: 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS Duct Leakage Test — Existing Duct System Eage 2 of 2 Site Address: Enforcement Agency: Permit Number: d ; f O Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off during duct leakage testing. CFI OA ducts that utilize controlled motorized dampers, that open only when OA ventilation is required to meet ASHRAE Standard 62.2, and close when OA ventilation is not required, may be configured to the closed position during duct leakage testing - 13 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 all accessible leaks) described above. 0 New duct installations cannot utilize building cavities as plenums or platform returns in lieu of ducts. Mastic and draw bands must be used in combination with cloth backed rubber adhesive duct tape to seal leaks at all new duct connections. DECLARATION STATEMENT • I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. • I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized representative of the person responsible for construction (responsible person). • I certify that. the installed features, materials, components, or manufactured devices identified on this certificate (the installation) conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the enforcement agency. • I understand that a HERS rater will check the installation to verify compliance, and that that if such checking identifies defects, I am required to take corrective action at my expense. I understand that Energy Commission and HERS provider representatives will also perform quality assurance checking of installations, including those approved as part of a sample group but not checked by a HERS rater, and if those installations fail to meet the requirements of such quality assurance checking, the required corrective action and additional checking/testing of other installations in that HERS sample group will be performed at my expense. • I reviewed a copy of the Certificate of Compliance (CF -IR) form approved by the enforcement agency that identifies the specific requirements for the installation. I 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 available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. I will ensure that all Installation Certificates will come from a HERS provider data registry for multiple orientation alternatives, and beginning October 1, 2010, for all low-rise residential buildings. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) Responsible Person's Name: Responsible Person's Signature: CSLB License: (off 3 �o Date Signed: Position With Company (Title): la - - /O Is this installation monitored by a Third Party Quality Contro Name of TPQCP (if applicable): Program (TPQCP)? Dyes Wo Registration Number: Registration Date/Time: HERS Provider: 2008 Residential Compliance Forms, August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Char a Verification - Standard Measurement Procedure fte 1 of Site Address: Enforcement Agency: Permit Number: G261,h, 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 fonn(s) for any additional systems in the dwelling as applicable. Temperature Measurement Access Holes ('TMAH) and Saturation. Temperature Measurement Sensors (SIMS) Procedures for installing TMAH are specified in Reference Residential Appendix RA3.2. If refrigerant charge verification is required for compliance, TMAH are also requiredfor compliance. SIMS are only required for completely new or replacement space -conditioning systems that utilize prescriptive compliance method. TMAH - Access Holes in Supply and Return Plenums of Air Handler System Name or Identification/Tag System Location or Area Served The sensor is factory installed, or field installed according to manufacturer's 3 ❑Yes ❑No specifications, or is installed by methods/specifications approved by the Executive Director. 1 es ❑No 5/16 inch (8 mm) access hole upstream of evaporative coil in. the return plenum and ❑Yes ❑No digital thermometer. The sensor mini plug is accessible to the installing technician and labeled according to Figure in Section RA3.2.2.2.2. 2 ❑No 5/16 inch (8 nun) access hole downstream of evaporativecoil ' e supply plenum ❑Yes es The sensor measures the saturation temperature of the coil within 1.3 degrees F 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 ✓ M46s ✓ ❑ Fail STMS - Sensor on the Evavorator Coil System Name or Identification/Tag The sensor is factory installed, or field installed according to manufacturer's 3 ❑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 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 The sensor measures the saturation temperature of the coil within 1.3 degrees F Yes to 3, 4, and 5 is a pass. Enter I ✓A ✓ 13 Pass ✓ 13 Fail N/A if STMS are not applicable. Otherwise enter Pass or Fail STMS - Sensor on the Condenser Coil System Name or Identification/Tag The sensor is factory installed, or field installed according to manufacturer's 6 ❑Yes ❑No specifications, or is installed by methods/specifications approved by the Executive Director. The sensor wire is terminated with a standard mini plug suitable for connection to a 7 ❑Yes ❑No digital thermometer. The sensor mini plug is accessible to the installing technician and the HERS rater without changing the airflow through the condenser coil 8 ❑Yes ❑No The sensor measures the saturation temperature of the coil within 1.3 degrees F Yes to 6, 7, and 8 is a pass. Enter /A ✓ 13 Pass ✓ 13 Fail N/A if STMS are not applicable. Otherwise enter Pass or Fail Registration Number: - Registration Date Time: HERSProvider: 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant CharLe Verification - Standard Measurement Procedure Tage 2 of Site Address: Enforcement 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 available in Reference Residential Appendix RA3.2. As many as 4 systems in the dwelling can be docurnented for compliance using this form Attach ar additional form(s) for any additional systems to 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 SS °F or below, the installer must use theAlternate Charge Measurement Procedure. Space Conditioning Systems System Name or Identification/Tag 9 _ 2 _ �Q (must be re -calibrated monthly) Date of Thermocouple Calibration 9 Z je _ a System Location or Area Served Od Outdoor Unit Serial # Outdoor Unit Make Lyi�O,L' Outdoor Unit Model X2/ OY8'Z30 Nominal Cooling Capacity Btu/hr Date of Verification �� •— �� Calibration of Diagnostic Instruments Date of Refrigerant Gauge Calibration 9 _ 2 _ �Q (must be re -calibrated monthly) Date of Thermocouple Calibration 9 Z je _ a (must be re -calibrated monthly) Measured Temperatures (°F) System Name or Identificaiion/Tag Supply (evaporator leaving) air dry-bulb temperature (Tau I , db) Return (evaporator entering) air dry-bulb To / temperature (Tretum, db) Return (evaporator entering) air wet -bulb temperature (Tretorn, wb) Evaporator saturation temperature (Tevat3orator, saO Condensor saturation temperature (Tconde or, sat) Suction line temperature (Tsuction) / (� Liquid Line Temperature (Tliquid) 7 Condenser (entering) air dry-bulb yI temperature (Tcondemer, db) (/ Registration Number: Registration Date/Time: HERSProvider: 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification -Standard Measurement Procedure (Page 3 of Site Address: Enforcement Agency: Permit Number: Ys` O 7D i r� .Minimum Airflow Requirement Temperature Split Method Calculations for determining Minimum Airflow Requirement for Refrigerant Charge Verification. The temperature split method is specified in Reference Residential Appendix RA3.2. System Name or Identification/Tag Calculate: Actual Temperature Split = Tretum, db - Tsupply, db / Target Temperature Split from Table RA3.2-3 using Tretum, wb and Tret r, , db / 9 Calculate difference: Actual Temperature Split — Target Temperahire Split = O Passes if difference is between -3°F and +3°F or, upon remeasurement, if between -3°F'and =100°F Enter Pass or Fail / Note: Temperature SplitMethod 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 CalculatedMinimum Airflow Requirement in the table below. Calculated Minimum Airflow Requirement (CFM) = Nominal Cooling. Capacity (ton) X'300 (cfm/ton) System Name or IdentificationfIag 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 ' . , )cedure is required to be used for HERS Provider: August 2009 INSTALLATION CERTIFICATE CF -6R MECH-25-HERS Refrigerant Charge Verification -Standard Measurement Procedure. (Page 4 of Site Address: Enforcement Agency: Permit Number: S -DSD 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 DR F Calculate: Actual Subcooling 7 Tcondenser, sat — Tli idd Target Subcooling specified by manufacturer �--- Calculate difference: 7- $ Actual Subcoo — Target Subcooling_ i System passes if difference is between -3°F and +3°F Enter Pass or Fail Metering Device Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identificatioru Tag DR F 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 specification is not available System passes if actual superheat is within the allowable superheat range Enter Pass or Fail Registration Number: Registration DatelTmme: HERSProvider: 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure e 5 of Site Address: 7Enforcement Agency: Permit Number: 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 ©,p/� System meets all refrigerant charge and airflow requirements. Enter Pass or Fail DECLARATION STATEMENT e I certify under penalty of pedury, under the laws of the State of California, the information provided on this form is true and correct. e 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). e I certify that the installed features, materials, components, or manufactured devices identified on this certificate (the installation) conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the enforcement agency. e I understand that a HERS rater will check the installation to verify compliance, and that that if such checking identifies defects, I am required to take corrective action at my expense. I understand that Energy Commission and HERS provider representatives will also perform quality assurance checking of installations, including those approved as part of a sample group but not checked by a HERS rater, and if those installations fail to meet the requirements of such quality assurance checking, the required corrective action and additional checking/testing of other installations in that HERS sample group will be performed at my expense. e I reviewed a copy of the Certificate of Compliance (CF -IR) form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF -1R that apply to the installation have been met. e I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the building permit(s) Issued for the building, and made available to the enforcement agency for all applicable inspections: I understand that a signed copy of this Installation Certificate is required to be Included with the documentation the builder provides to the building owner at occupancy. I will ensure that all Installation Certificates will come from a HERS provider data registry for multiple orientation alternatives, and beginning October 1, 2010, for all low-rise residential buildings. Company Name: (Installliing Subcontractor or Gene Contractor or Builder/Owner) Responsible Person's Name: Responsible Pe n's Si nature: CSLB License: 69G31v Date Signed: A9 Position With Company (Title): Is this installation monitored by a Third Party Quality Contr Name of TPQCP (if applicable): Program (TPQCP)? DYes JTNo Registration Number: Registration Date/Pine: 2008 Residential Compliance Forms HERS Provider: August 2009