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11-1190 (MECH)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: ;11-00001190, Property Address: 79465 BROOKVILLE APN: 772-040-009- - Application description: MECHANICAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 10366 Tiht 4 4,Q" Applicant: Architect or Engineer: pl A ------------------ LICENSED CONTRACTOR'S DECLARATION BUILDING & SAFETY DEPARTMENT BUILDING PERMIT I hereby affirm under penalty of perjurXamexempt that.1nder provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Buls Code, and my License is in full force and effect. License Class: C20cense No.: 686310 1 ate: O ontractor: ILDER DECLARATION I hereby affirm under penalty of perjurom 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 ISec. 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 improve4or 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 contractor(s) licensed pursuant to the Contractors' State License Law.). 1 _ ) I am exempt under Sec. , BAP.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 (See. 3097, Civ. C.). Lender's Name: Lender's Address: LQPERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 11/01/11 Owner: NYLUND BOB 79465 BROOKVILLE LA QUINTA, CA 92253. Contractor: I 012011 GENERAL AIR CONDITIONING 31170 RESERVE DRIVE' CITYOFI.AQUINTA THOUSAND PALMS, CA 92276 FINANcE oPT. (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 EVEREST NATL Policy Number 7600006147101 I certify that, in the performance of the ork for which this permit is issued, I shall not employ any person in any manner. so as to beco a ubject to the workers' compensation laws of California, and agree that, if I should become bj ct to the workers' compensation provisions of Section 3700 of the Labor Code, I shall fo ith comply with those provisions. te: l (plicanY WARNING: FAILURE TO SECURE WOR S' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. 1 . Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application, the owner, and the applicant, each agrees to, and shall defend, indemnity 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 s ation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above info ion is correct. I agree to comply with all city and county ordinances and state laws relating to building constr c y and hereby authorize representatives of this county to enter upon a above-mentioned property for inspe ti fi urposes. D e: 11 nature (Applicant or Agent): Application Number . . . . . 11-00001190 Permit . . . MECHANICAL Additional desc . Permit Fee . . . . 40.50 Plan Check Fee 10.13 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 4/29/12 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 9.0000 EA MECH FURNACE <=100K 9.00 1.00 16.5000 EA MECH B/C >3-15HP/>100K-500KBTU 16.50 ---------------------------------------------------------------------------- Special Notes and Comments CHANGE OUT HVAC SYSTEM: FURNACE, CONDENSER, INDOOR COIL. GROUND LEVEL. 2010 CODES. ---------------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged --------------------------- Paid Credited -------------------- Due ---------- Permit Fee Total 40.50 .00 .00 40.50 Plan Check Total 10.13 .00 .00 10.13 Other Fee Total 1.00 .00 .00 1.00 Grand Total 51.63 .00 .00 51.63 LQPERMIT Simplified- Prescriptive Certificate of Compliance:- 2008..Residential HVAC Alterations CF -IR -ALT -HVAC ` Climate Zones IO'to IS Site Address: // / En orcein t Agency• Date: Permit #: Conditioned Floor Equipment T et List Minimum Efficient 2 Duct insulation requirement Area Thermostat Packaged Unit ❑ AFUE90% ❑ COP Over 40 ft of ducts added or Setback rnate oor Coil ❑SEER 13 ❑ HSPF replaced in unconditioned space Served by system (If not already ndensing Unit rCo0ther ❑EER R/ / ❑Resistance ❑ R 6 (CZ l0-13) ❑ R 8 (CZ 14-15) sf prose»r, murr be installed) 1. Equipment Type: Choose the equipment being installed: if more than one system, use another CF -1 R -ALT -HVAC jor each system. 2. Hinimum Equipment Efficiencies: 13 SEER, 78% AFUE, 7.7HSPF for typical residential systems. HERS VERIFICATION SUMMARY Listed below are four HVAC alteration Options. The installer decides what work is being done and picks one of the appropriate Options. Each Option lists the HERS measures that must be conducted. A copy of the forms shall be left on site for final inspection and a copy given to the homeowner. At final, the inspector verifies that the work listed on this form was in fact the work completed by the installer. The inspector also verifies that each appropriate CF -6R and registered CF -4R forms (no hand filled CF-4Rs allowed) are filled out and si ed. Beginning October 1, 2010, a registered copy of the CF -IR and CF -611 shall also be on site for Qnal inspection. Al. HVAC Changeout Required Forms: _G All HVAC Equipmerii replaced -' CF -61Z forms: MECH-04, MECH-2I-HERS and (for split systems) MECH- 25 -HERS - CF -4R forms: MECH- 21 and fors lits stems MECH-25 • Condenser Coil and/or CF -6R forms: MECH-2I-HERS and (for split systems) MECH- 25 -HERS • Indoor Coil and/or CF -4R forms: MECH- 21 and (for split systems) MECH-25 • Furnace For Split Systems: Duct leakage < 15 percent; RC, CCA > 300 CFM/ton(Minimum Air Flow Requirement), TMAH For Packaged Units: Duct leakage < 15 percent Exempted f duct leakage testing iE 1. Duct system was documented to have been previously sealed and confirmed through HERS verification, or VV -;— /®r2. 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 CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS ducts: (all new ducting and all CF -4R forms: MECH 20-, and (for split systems)MECH-22, and MECH 25 new equipment) For Split Systems: Duct leakage < 6 percerit; RC, CCA > 350 CFM/ton, FWD, TMAH, STMS, and either HSPP or PSPP. For Packaged Units: Duct leakage < 6 percent ❑ 3. New Ducts with Replacement Required Forms: • Includes replacing or installing all new ducting CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-25-HERS and/or outdoor condensing unit and/or indoor CFVR 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 114. New Ducting over 40 feet Required Forms: • Includes adding or replacing more than 40 CF -6R forms: MECH-04, MECH-2I-HERS CF -4R forms: MECH-21 linear feet of duct in unconditioned space. For split system or packaged units: Duct leakage < 15 percent ❑ EXCEPTION: Existing ducts stems constructed, insulated or sealed with asbestos. Contractor (Documentation Author's /Responsible Designer's Declaration Statement) • I certify that this Certificate of Compliance documentation is accurate and complete. • I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of Compliance. • I certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24, Parts i and 6 of the California Code of Regulations. • The design features identified on this Certificate of Compliance are consistent with the orm tion documented on other pylic ompliance forms, worksheets, calculations, plans ands specifications submitted to the enforcement agency fora ro al with t e permit application. Name: Co It een 1#0-;(-6 6 Sig ture: Company: l± ell et,,aj 41'r Condi it �`o A r` Date: �Q 3C lI Address: _311-7 �t°Ser'v2 ,� wrt ✓� License: 686,3/6) k-ty/State/Zip:��-7-A-0PaA(-/&_ S, Phone: -760 ,.3 143 _ 7 4ek Ca10ERTS - CF -1 R Registration Page 1 of 1 Public Home Danielle Garcia logged in [Logout] [Home] Secure Home About Us Training Rater Directory Forms Membership Benefits Events Industry Partners News To register for our monthly newsletter, please click here. _ CONGRATULATIONS Your CF -IR -ALT -HVAC Registration is complete! You may want to print this page for your records. Site Address- 79465 BROOKVILLE La Quinta, CA 92253 CEC Registration: 211-A0056607A-00000000-0000 CF -IR -ALT -HVAC: CLICK HERE TO DOWNLOAD Assigned Company: HARRISON ENTERPRISES INC Do you know your HERS Rater? If you do, you may want to send this CF -IR to them. Ca10ERTS Rater ID: OR My Rater Quick Select: Energy Driven Solutions, Inc. Every Ca10ERTS rater has a license number. If you need to find the rater by name [Click HERE) to search our directory. I ,r$END CF-4RrT0 HERS RATER I [CLICK HERE] to do another Copyright ,u 2010 Ca10ERTS. Inc. All rights reserved. Revised: January 11, 2010 [Terms and Conditions] [Privacy Statement] [Class Cancellation Policy] CaICERTS, Inc., 31 Natoma St Suite 120, Folsom, CA 95630 Office: 916-985-3400,Toll Free: 877-HERS-R8R, (877-437-7787) Fax: 916-985-3402 Contact Us r' s T BBB fiindusonFaoebOOk91 wn BBB haps://www.calcerts.coni/public_cflR.cfm?project_id=146966 10/31/2011 Bin # Qty Of LA Quinta Building 8r Safety Division Permit #" P.O. Box 15.04, 78-495 Calle Tampico ,`�� La Quinta, CA 92253 - (760) 777-7012 1l Building Permit Application and. Tracking Sheet , Project Address: ' , (�� r �� Owner's Name: A. P. Number: Address: -7.07if Legal Description: City, ST, Zip: �a— Contractor: Address: OD Telephone: 3 . �' " -. ' ' Project Description:_3t �� City, ST, Zip: 7V � 1,` 5004 O / � � ;<;«:>?:::?>�.�;:•,`•� ;a:HAY• Telephone: 3 �? :`'� %% '%'`''%`'s State Lic. # : 3 CityLic. #; 31410 1P Arch., Engr., Designer: Address: -City, ST, Zip: Telephone: 4' ; ��?'''':�� State Lic. #; Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo Name of Contact•Person: Gp &.-t L1,0,c%65 OYU Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: —7& 'l �' g Estimated Value of Project: /Q APPLICANT: DO, NOT WRITE. BELOW THIS LINE # Submittal Req'd Rec'•d TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cales. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance. Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan V. Review, ready for correctionslissue 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 FII Total Permit Fees CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING V CF-4R-MECH-21 Duct Leakage Test — Existing Duct System (Page 1 of 2) Site Address: Enforcement Agency: Permit Number: 79465 BROOKVILLE, La Quinta CA 92253 (System 1) 1 City of La Quinta 11-1190 =nter the Duct System Name or Identification/Tag: nter.the Duct System Location or Area Served: Vote: Submit one Installation Certificate for each duct system that must demonstrate compliance in the swelling. This installation certificate is required for compliance for alterations and additions in existing dwellings to space conditioning systems and duct systems. Vote: For existing dwellings, a completely new or replacement duct system can also include existing parts of `he 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, ise the Installation Certificate titled "Duct Leakage Test. - Completely New or Replacement Duct System. " Duct Leakage Diagnostic Test - existinq duct system Select one compliance method from the following four choices. 1. Measured leakage less than 15% of fan flow o 2. Measured, leakage to outside.,less than 10% of Fan Flow •_ "" _ n 3. Reduce leakage by 60% and conduct smoke and fix all leaks n 4. Fix all accessible, leaks using smoke and HERS rater verify Note:,,(One of Options 1, 2, or 3 must=be attempted before utilizing Option 4.) Determine nommakFanyFlow using one of the following three calculation methods W a O Cooling em=method: Size o condenser -An Tons CFM#4 y r a h:& of Bt/hey O Heatmgsystem method,. Z1 7x# Output Capacity m Th�ousandR-mVNl Ed mg _CFM y� Lxg ✓ ❑ Measured RA3 3,airFlow�test system airflo�w using procedures: OpUoni used then'�� x . 1 Allowed leakage xFan Flow xs0 15 CFM ., -..... .:. .., ....::: x: Actual Leakage = _CFM Pass if Leakage Actual is less than Allowed Pass Fail Optildnx2)usdd then: �< Allovvetl =Fan ix Z leakage Flow 0.10 = _ CFM Actual Leakage to outside i:f' Pass if Leakage Actual is less than Allowed Pass Fail Option 3 used then: Initial leakage prior to start of work = _ CFM Final leakage after sealing all accessible leaks using smoke test = _ CFM 3 Initial leakage _ - Final leakage _ = Leakage reduction CFM ((Leakage reduction _ / Initial leakage _) x 100% _ % Reduction Pass if % Reduction > 60% Pass Fail Option 4 used then: 4 All accessible leaks repaired using smoke. HERS rater must verify (No sampling). No smoke allowed to leak from system. Including ducts, plenums, air handler and door panel. Pass if all accessible leaks have been repaired using smoke Pass El Fail Reg: 211-A0056607A-M2100001A-M21A Registration Date/Time: .2011/12/02 18:46:18 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4111-MECH-21 Duct Leakage Test - Existing Duct System (Page 2 of 2) Site Address: Enforcement Agency: Permit Number: 79465 BROOKVILLE,, La Quinta CA 92253 (System 1) City of La Quinta 11-1190 0 Outside air (OA) ducts for Ce during duct leakage testing. CF ventilation •is.required to meet be configured to the closed pos O All supply and�ret� urn register - appllestoduct-leakage comp) leaks) described above. O New duMinstalla 0 Mastic leaks at ral Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off M ducts that utilize, controlled motorized dampers, that open only when OA ,HRAE Standard 62.2, and close'when OA ventilation is not required, may on during duct leakage testing. gots must be,tsealed-to the dr;yw allgif smokegtest�ismutillzedgfor compliance ce option 3'(tl�eakage reduction by60%,)andoptlon4 (f xalla�ccessible 10 t� lie. buildin�gg cava plen�umsorpl4�atformetuln l eu��duct '" DECLARATION'STATEMENT; • I certify under penalty of`perjury, unde[:the laws of the State of California, the information provided on this form is true and correct. Abp.. • 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 appli'cab'le requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified on the Certificate(s) of Compliance (CF -111) approved by the local enforcement agency. • The information reported on applicable sections of the Installation Certificate(s) (CF -6R), signed and submitted by the person(s) responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -SR) approved by the enforcement agency. Builder or Installer information as shown on the Installation Certificate (CF -6111) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) HARRISON ENTERPRISES INC Responsible Person's Name: CSLB License: Danielle Garcia 1686310 HERS Provider Data Registry Information Sample Group # (if applicable): 258030 ❑ tested/verified dwelling 0 not-tested/verified dwelling in la HERS sample group HERS Rater Information CalCERTS Certificate # CC1-1798604097 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: 11/30/2011 CC2004131 Reg: 211-A0056607A-M2100001A-M21A Registration Date/Time: 2011/12/02 18:46:18 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 1 of 5) Site Address: Enforcement Agency: Permit Number: 79465 BROOKVILLE, La Quinta CA 92253 City of La Quinta 11-1190 Note: If installation of a Charge Indicator Display (CID) is utilized as an alternative to refrigerant charge verification for compliance, a MECH-24 Certificate (instead of this MECH-25 Certificate) should be used to demonstrate compliance with the refrigerant charge verification requirement. TMAH and STMS are not required for compliance, when a CID is utilized for compliance. As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional form(s) for any additional systems in the dwelling as applicable. Temperature Measurement Access Holes (TMAH) and Saturation Temperature Measurement Sensors (STMS) Procedures for installing TMAH are specified in Reference Residential Appendix RA3.2. If refrigerant charge verification is required for compliance, TMAH are also required for compliance. STMS are only required for completely new or replacement space -conditioning systems that utilize prescriptive compliance method. TMAH - Access Holes in Supply and Return Plenums of Air Handler System Name or Identification/Tag System Location or Area Served 3 i ®des -,16. inch -P.m. -access •hale=upstr.eam•.of evaporative coil in. the -.return plenum and- n i - labeled 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 ,1. and -2 is a pass. ;': Enter Pass or Faill ✓ ❑ Pass ✓ ❑ Fail STMS - Sensor onAhe Evaporato C6il.... _.- -. System`Nam`i�ori"Id6'nt,,fcation/Tag" let MUM Wr, : 3 i ®des ®Na Th`&96hsor is facto installed; or feldAngtalllled according Eo inanufactiirer s "tions, , _ _ specifications, or is installed by rnetFiods/speeifica3tions�epproved bythe Executive ❑ Yes ❑ No specifications, or is installed by methods/specifications approved by the Executive ��.��~x�,.; 4 ❑p' f, p Nom isorw,iie is terminated with`a standard mini plug suitable for6corinection to a digital thermometer The en o plug islac a ssa le to , insta ling technicia q4,0nd the HERS rater with�outsehangmg-the aialow�_through the condenser coil 5 ❑ Yes ❑ No When attached to a digital thermometer, the sensor provides an indication of the saturation temperature of the coil. y 8 Yes to`1*14 ana 51sa`pass. Enter N/A if STMS are not ,/ ❑ N/A ✓ ❑Pass ✓ E] Fail applicable. Otherwise en0,Pass oFail saturation temperature of the coil. Yes to 6, 7, and 8 is a pass. Enter N/A if STMS are not STMS - Sensor on the Condenser Coil System Name or Identification/Tag The sensor is factory installed, or field installed according to manufacturer's 6 ❑ Yes ❑ No specifications, or is installed by methods/specifications approved by the Executive Director. The sensor wire is terminated with a standard mini plug suitable for connection to a 7 ❑ Yes ❑ No digital thermometer. The sensor mini plug is accessible to the installing technician and the HERS rater without changing the airflow through the condenser coil 8 ❑ Yes ❑ No When attached to a digital thermometer, the sensor provides an indication of the saturation temperature of the coil. Yes to 6, 7, and 8 is a pass. Enter N/A if STMS are not ✓ N/A ✓ E] Pass ✓ ❑Fail applicable. Otherwise enter Pass or Fail Reg: 211-A0056607A-M2500001A-M25A Registration Date/Time: 2011/12/02 18:48:06 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5) Site Address: Enforcement Agency: Permit Number:, 79465 BROOKVILLE, 'La Quinta CA 92253 City of La Quinta. 11-1190 Standard Charge Measurement Procedure (for use if outdoor air dry-bulb is above 55°F) Procedures for determining Refrigerant Charge using the Standard Charge Measurement Procedure are available in Reference Residential Appendix RA3.2. As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional form(s) for any additional systems in the dwelling as applicable. • The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure. • The system must meet minimum airflow requirements as prerequisite for a valid refrigerant charge test. • If outdoor air dry-bulb is 55°F or below, the installer must use the Alternate Charge Measurement Procedure. Space Conditionina Svstems System Name or Identification/Tag (must be re -calibrated monthly) �::.. _ . System Location or Area Served Date of ThermocoupleCalibraCiony(mustbe%re`calibrated monthly) Outdoor Unit Serial # WK Outdoor Unit Make Outdoor Unit Model Nominal Cooling Capacity Btu/hr :. Date of Verification' cauoration or wannostic instruments Date `of Refrigerant Gauge Calibration;: (must be re -calibrated monthly) �::.. _ . Date of ThermocoupleCalibraCiony(mustbe%re`calibrated monthly) _ ...>a WK Mea sureil:Temperatures11(.°Fj�- _. : l MW System Name or Id,(e�njtific�ay'tlon/<Tag 'W*-t ... ... gip: Reg: 211-A0056607A-M2500001A-M25A Registration Date/Time: 2011/12/02 18:48:06 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 Supply (evaporator bulb��R temperature PPIYleavng)airdry (T -Su, db Return (evaporatogp-ntering) air dry<"bulb temperature�(Tret m '") � Return (evaporator entering) air wet=.bulb temperature (T ) return, wb Evaporator saturation temperature>'; (Tevaporator; sat) Condensor saturation temperature (Tcondensor, sat) Suction line temperature (Tsuction) Liquid Line Temperature (Tliquid) Condenser (entering) air dry-bulb temperature (Tcondenser, db) Reg: 211-A0056607A-M2500001A-M25A Registration Date/Time: 2011/12/02 18:48:06 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5) Site Address: Enforcement Agency: Permit Number: 79465 BROOKVILLE, La Quinta CA 92253 City of La Quinta ii -1190 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. Teripe� ato-re-S'plit 1�ho&C-artcutaticr, ,smotrecessary -if -actual Cooling Coll Hhflcw is -verified -using -one-of-rhe --- ak•flow measurement precedures spgcifiedin-Refereenze Residential Appendix RA3.3. If actual,cooling coi! airflow is measured, the value must be equb to or greater than the Calculated Minimum Airflow Requirement in the table below. Calculated Minimum Airflow Requirement (CFM) = Nominal Cooling Capacity (ton) X 300 (cfm/ton) tls: � System Name or "denpttiification/Tag"IM s ._ � rF` . .-,�" x...7��. ..'.:r'C4'`•� �'�fiR'. ... r _ c y CalculatedNMm:mum AirFlowgReGuirernent (vCFM)Al Pq � y it - " .T ..< k' yad3troeedu��idE�� MeasuredRAirflow using�RA33 pr�es (CFM)- Passes if rrieasured'a:rFlow`is: greater;,,fWi yo equal .. <:r a .:... s.• to the calculated minimum airFlow-requirement„ -- Enter Pass or Fail Superheat Charge Method Calculations for Refrigerant Charge Verification. This. procedure is required to be used for fixed orifice metering device systems System Name or Identification/Ta61 Y 9` -` 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 13 Reg: 211-A0056607A-M2500001A-M25A Registration Date/Time: 2011/12/02 18:48:06 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-411-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page.4 of 5) Site Address: Enforcement Agency: Permit Number: 79465 BROOKVILLE, La Quinta CA 92253 City of La Quinta 11-1190 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 �u� ` -4°F and +4°F 1.. 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.. -ystezn-Name-or dentifrcatiorri.T-sy"":..--..`_ _. -......._ Calculate: Actual Superheat Tsuction - Tevaporator, sat Enter allowable superheat range frdm: manufacturers specifications (or usejrange between 3°F and 26°F if manufactu0er?s specification is not available) rr, System' , s if actual.su erheat is within they asse Y Pat 4 : P r allowable superheat range �u� ` . Enter Pass or:."Fail 1.. Reg: 211-A0056607A-M2500001A-M25A Registration Date/Time: 2011/12/02 18:48:06 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 fNSTALLATION CERTIFICATE CF-4R-MECH-2: tefrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5. Site Address: Enforcement Agency: Permit Number: 79465. BROOKVILLE, La Quinta CA 92253 City of La Quinta 11-1190 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): 258030 System meets all refrigerant charge and airflow dwelling in a 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: 11/30/2011 CC2004131 DECLARATION STATEMENT • I certify.under penalty of perjury, under the laws of the State of California, the information provided on this form.is true and correct. fig,,.:. • I am the certified HERS rat&:0ho performed the verification services identified and reported on this certificate (responsible rater). e_ • 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 aoencv. Builder or Installer information as shown on the Installation Certificate (CF -6111) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) HARRISON ENTERPRISES INC Responsible Person's Name: CSLB License: Danielle Garcia 1686310 HERS Provider Data Registry Information Sample Group # (if applicable): 258030 ❑ tested/verified dwellingnot-tested/verified dwelling in a HERS sample group HERS Rater Information CaICERTS Certificate # CCl-1798604097 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: 11/30/2011 CC2004131 'Reg: 211-A0056607A-M2500001A-M25A Registration Date/Time: 2011/12/02 18:48:06 HERS Provider: CalCERTS, Inca 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS Duct Leakage Test — Existing Duct System (Page 1 of 2) Site Address: Enforcement Agency: Permit Number: 79465 BROOKVILLE, La Quinta CA 92253 (System 1) City. of La Quint a 11-1190 Enter the Duct System Name or Identification/Tag: System 1 Enter the Duct System Location or Area Served: kitchen Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the dwelling. 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. " Select one compliance method from the. following four choices. 0 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 3x_ a S? 4. Fix- all,. accessible leaks using smoke and HERS rater verify Note%(One of Options 1, 2 or 3 must tie attempted before utilizing Option 4.) Determine nominal Fan Flow using d6 of th.e following three calculation methods ✓ Cooling.. syst6m method: Size of condenser m Wis"17 N �,�� 400a E200 - I r x f ✓ 0 Heating system method' 21 7�x f A0utput capacity, '1uthZusdnds of Btu/hr��= CFM �' ✓ O Mei sQ ed system airflow,cus ng RA313 airFlow test prkocedures. _ 5 CF.M , Allowedleakag"e�FanAirflow;�w"1200�x Actual Leakage = "`126 CFM�r s, Pass if Actual Leakage is less than Allowed leakage pq Pass n Fail O0tidW2 used then 2 Allowed leakage Pan Airflow_' x 0.10 = _ CFM Actual Leakage to outside - P=:CFM Pass if Actual leakage to outside is less than Allowed leakageEl Pass 0 Fail Option 3 used then: Initial leakage prior to start of work = _ CFM Final leakage after sealing all accessible leaks using smoke test = CFM 3 Initial leakage _ - Final leakage _ = Leakage reduction CFM ((Leakage reduction _ / Initial leakage__) x 100% _ % Reduction Pass if % Reduction > 60% ci Pass Ei Fail Option 4 used then: 4 All accessible leaks repaired using smoke test. HERS rater must.verify (No Sampling). Pass if all accessible leaks have been repaired using smoke Pass Fail Reg: 211-A0056607A-M2100001A-0000 Registration Date/Time: 2011/11/30 21:01:14 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-6R-MECH-21-HERS Duct Leakage Test - Existing Duct System (Page 2 of 2) Site Address: Enforcement Agency: Permit Number: 79465 BROOKVILLE, La Quinta CA 92253 (System 1) City of La Quinta 11-1190 0 Outside air (OA) ducts for.Ce during duct leakage testing. CF ventilation,is.required to meet be configured to'the.closed pos 2 All supplyaoFceturn register - applies kll to�duct�leSkage comp) leaks) den esbed above.. 0 New ductrinstall 2 MastiON' leaks at a I Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off k ducts that utilize controlled motorized dampers, that open only when OA RAE Standard 62.2, and close when OA ventilation is not required, may I during duct leakage testing. uilding drywalllf smoke, test isutillzedforcompliance tlon,byri60/o)and oponfi �4kallaccessible �numsFor platformreturns in heofducts ^ x • I certify under penalty of perjury, unde�.the laws of the State of California, the information provided on this form is true and correct. • I am eligible under Division •3':of the Business and Professions Code to accept responsibility for construction, or an authorized representative of the person responsible for construction (responsible person). • I certify that the installed features; materials, components, or manufactured devices identified on this certificate (the installation) conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the enforcement agency. • I understand that a HERS rater will check the installation to verify compliance, and that that if such checking identifies defects, I am required to take corrective action at my expense. I understand that Energy Commission and HERS provider representatives will also perform quality assurance checking of installations, including those approved as part of a sample group but not checked by a HERS rater, and if those installations fail to meet the requirements of such quality assurance checking, the required,corrective action and additional checking/testing of other installations in that HERS sample group will be performed at my expense. • I reviewed a copy of the Certificate of Compliance (CF -111) form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF -1R that apply to the installation have been met. . I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. I will ensure that all Installation Certificates will come from a HERS provider data registry for multiple orientation alternatives, and beginning October 1, 2010, for all low-rise residential buildings. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) HARRISON ENTERPRISES INC Responsible Person's Name: Responsible Person's Signature: Danielle Garcia Danielle farcia CSLB License: Date Signed: Position With Company (Title): 686310 11/7/2011 Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? ❑ Yes ❑ No Reg: 211-A00566.07A-M2100001A-0000 Registration Date/Time: 2011/11/30 21:01:14 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE* CF-6R-MECH-25-HER! tefrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 5' Site Address: Enforcement Agency: Permit Number: 79465 BROOKVILLE, La Quinta CA 92253 City of La Quints 11-1190 i 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 SIMS are not required for compliance, when a CID is utilized for compliance. As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional form(s) for any additional systems in the dwelling as applicable. Temperature Measurement Access Holes (TMAH) and Saturation Temperature Measurement Sensors (STMS) Procedures for installing TMAH are specified in Reference Residential Appendix RA3.2. if refrigerant charge verification is required for compliance, TMAH are also required for compliance. STMS are only required for completely new or replacement space -conditioning systems that utilize prescriptive compliance method. TMAH - Access Holes in Supply and Return Plenums of Air Handler System Name or Identification/Tag System 1 System Location or Area Served Kitchen 3 - ®Yes 5/1nch (8, mm) access hole upstream of evaporative coil in the return_penum and ❑ No�- %' 6 ilabeled according to Figure.in Sectlon.RA3.2.2�2.2. T 2 0 Yes El 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 ✓ 0 Pass ✓ ❑Fail STMS`- Sensor on -the Evaporator Coil S stem°Narnegor Identification/Tag y ; RSystem i �A.9111 3 ' ®=Yes ®ANO FThe sensor s factor l stalllled,:,'i field ai; stalled accordding -toymanufacturer s speafications or is installed by methods/specifications approved by the Executive El El No specifications, or is installed by methods/specifications approved by the Executive Director. ®Y�es ffiiil�l ®ff Thesensor wwiire in erminate w th a sandard mini plug suitable foconnect ori t4 ermometer�Thesensormm;plugpseccessible to ttieinstalingtechnic an ❑ Yes ❑ No Vat -N�dgitalt og,•. a~s+T 8wE. the through the . -; andhhe�HERS raterw�thout changing airflow condenser coil 5 ❑ Yes ❑. No Jhe sensor measures the saturation temperature of the coil within 1.3 degrees F Yes'to-3; 4;zand- 5 is=a;.pass. Enter N/,A!if STMS are not applicable 'Ot"._' ge enter Pass or, Fa -1 ✓ 2 N/A ✓ El Pas ✓ ❑Fail STMS - Sensor on the Condens 'Coil System Name or Identification/Tag I System i The sensor is factory installed, or field installed according to manufacturer's 6 El El 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 N/A if STMS are not ✓ N/A ✓ ❑Pass ✓ ❑Fail applicable. Otherwise enter Pass or Fail Reg: 211-A0056607A-M2500001A-0000 Registration Date/Time: 2011/11/30 21:02:49 HERS Provider: CalCERTS, Inc. 2008'Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5) Site Address: Enforcement Agency: Permit Number: 79465 BROOKVILLE, La Quinta CA 92253 City of La Quinta 11-1190 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 iystem should be installed and charged in accordance with the manufacturer's specifications before starting this procedure. • The system must. meet minimum airflow requirements as prerequisite for a valid refrigerant charge test. • If outdoor air dry-bulb is 55°F or below, the installer must use the Alternate Charge Measurement Procedure. , Space Conditioning Systems System Name or Identification/Tag System 1' (must be re -calibrated monthly) :. ti Date of T,herrnocou IeCalibration _ p , : 1, j ' System Location or Area Served Kitchen , . -.i ..,: ustAbel.r Outdoor Unit Serial # 5811FO1119 ... Outdoor Unit Make Lennox Outdoor Unit Model XC21-036 Nomhnal-Cooling Capacity-Btu/hr Date of Verification; ;t 11-7-11 Calibration of Diagnostic Instruments Date'of Refrigerant Gauge CalibratioN g g 11-i-11 (must be re -calibrated monthly) :. ti Date of T,herrnocou IeCalibration _ p , : 1, j ' i�, calibrated monthlY). ¢ „ , . -.i ..,: ustAbel.r Measured Temperatures teem 1 � � Y �, �� •� �a Ste- f`�` ff AW'.'_ 3p System Name or Identifcation/�Tagr Sys Supply (evaporator�leavrrig)air�dry `bulb temperature(Tsu � ... I db) ff AW'.'_ 3p System Name or Identifcation/�Tagr Sys Supply (evaporator�leavrrig)air�dry `bulb temperature(Tsu � ... I db) Return (evaporatorentering) air dry' bylb temperature;=(T^ 69 Return (evaporator entering) air wet=tiulb 50 temperature (T return, wb) "` Evaporator saturation temperature: 34 (Tevaporator, sat) Condensor saturation temperature 66 (Tcondensor, sat) Suction line temperature (Tsuction) 46 Liquid Line Temperature (Tliquid) 63 Condenser (entering) air dry-bulb 68 temperature (Tcondenser, db) Reg: 211-A0056607A-M2500001A-0000 Registration Date/Time: 2011/11/30 21:02:49 HERS Provider: CalCERTS, Inc. 2008 Residential.Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-611-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5) Site Address: Enforcement Agency: Permit Number: 79465 BROOKVILLE, La Quinta CA 92253 City of La Quinta 11-1190 Minimum Airflow Requirement Temperature Split Method Calculations for determining Minimum Airflow Requirement for Refrigerant Charge Verification. The temperature split method is specified in Reference Residential Appendix RA3.2. System Name or Identification/Tag System 1 Calculate: Actual Temperature Split = Treturn, 21.00 db - Tsupply,db Target Temperature Split from Table RA3.2-3 19 using Treturn, wb and Treturn, db" Calculate difference: Actual Temperature Split - 2 Target Temperature Split = Passes if difference is between -3°F and +3°F or, upon remeasurement, if between -3°F and PASS -100°F Enter Pass or Fail Note:.Temperature,, oUt-Pethocf-p-IculatiQn•is not.necessary if actual_Cooling.Coil.�irf12�!/� yerlFQd�siPQ•or�0..of_the_. airflow measurement procedures specified in Reference Residential Appendix RA3.3. If actual cooling coil airflow /s measured, the value must be equal to or greater than the Calculated Minimum Airflow Requirement in the table below. ru CalculatedMinimumAirflow Re4_.ir_ement [CFM) Nominal Cooling Capacity (ton)X 300(cm/ton ) S stem Nam o~Identification a ' /T 9 a. S Y yxk`,.?'.".. OW ?,Y ,.k ra Calculated Minimum Airflow.Requirement�(CFM) f MeasurediAiMow usin <A3° rocedures (CFM) ••s�..p,,e``w,:f`,`.isi„'r ,k,s�.�..,i c.s.,',.a: .,z`L°. ` �!`, s.:. r?.°i.s.. ,;&*3 "•p�'�,,A� .1,. .,ae R�`d° i Passes if measured airflow is g�eatei; than of�`..:•• 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`sysfems System Name or Identification/Tag System .1 Calculate: Actual Superheat = Tsuction - Tevaporator, sat Target Superheat from Table RA3.2-2 using Treturn, wb and Tcondenser, db Calculate difference: Actual Superheat - Target Superheat = System passes if difference is between -5°F and +5°F Enter Pass or Fail Reg: 211-A0056607A-M2500001A-0000 Registration Date/Time: 2011/11/30 21:02:49 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5) Site Address: Enforcement Agency: Permit Number: 79465 BROOKVILLE, La Quinta CA 92253 1 City of La Quinta 11-1190 Subcooling Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TW) and electronic expansion valve (EXV) systems. System Name or Identification/Tag System 1 a ... _, _. Calculate: Actual Subcooling = 3.0 Enter allowable superheat range from;. manufacturer's specifications (or use, range Tcondenser, sat - Tliquid ' between 4°F and 25°F if manufacturer's Target Subcooling specified by manufacturer 2.5 specification is not available) ) Calculate difference: 0.5 System passes if actualsuperheat is-within-theZ �Yi..':'. h: gni.: Y, s"'J f"{` allowable serheat rangea Actual Subcooling - Target Subcooling = 22 - x { s I if�y Enter•Pass or Fail .cE,> ';fru.-.zc vh4.e�•1. n $.vza z..`r System passes if difference is between :Wits -3°F and +30F PASS Enter Pass or Fail Metering Device Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System. Name oL Identifcation/Tag System 1..t 12.0 a ... _, _. Calculate: Actual Superheatl- it-: Tsuction - Tevaporator, sat,`: Enter allowable superheat range from;. manufacturer's specifications (or use, range 25 between 4°F and 25°F if manufacturer's specification is not available) ) System passes if actualsuperheat is-within-theZ �Yi..':'. h: gni.: Y, s"'J f"{` allowable serheat rangea y k�e PASS" 22 - x { s I if�y Enter•Pass or Fail .cE,> ';fru.-.zc vh4.e�•1. n $.vza z..`r h. :Wits 13 Reg: 211-A0056607A-M2500001A-0000 Registration Date/Time: 2011/11/30 21:02:49 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-25-HER: tefrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5 Site Address: Enforcement Agency: Permit Number: 79465 BROOKVILLE, La Quinta.CA 92253 City of La Quinta 11-1190 Standard Charge Measurement Summary: System shall pass both refrigerant charge criteria, metering device criteria (if applicable), and minimum cooling coil airflow criteria based on measurements taken concurrently during system operation. If corrective actions were taken, all applicable verification criteria must be re -measured and/or recalculated. System Name or Identification/Tag System i CSL'B License: 686310 Date Signed: 11/7/2011 position With Company (Title): System meets all refrigerant charge and airflow Name of TPQCP (if applicable): Control Program (TPQCP)? ❑ Yes ❑ No requirements. PASS Enter Pass or Fail ..., s .,a,.. _. ..... .. DECLARATION STATEMENT • I certify under penalty of perjury, und& the laws of the State of California, the information provided on this form is true and.correct. • I am eligible under Division3 of:,. Business and Professions Code to accept responsibility for construction, or an authorized representative of the person responsible for construction (responsible person). . I certify that the installed, features,' materials, components, or manufactured devices identified on this certificate (the installation) conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the enforcement agency. • I understand that a HERS rater will check the installation to verify compliance, and that that if such checking identifies defects, I am required to take corrective action at my expense. I understand that Energy Commission and HERS provider representatives will also perform quality assurance checking of installations, including those approved as part of a sample group but not checked by a HERS rater, and if those installations fail to meet the requirements of such quality assurance checking, the required corrective action and additional checking/testing of other installations in that HERS sample group will be performed at my expense. • I reviewed a copy of the Certificate of Compliance (CF -1R) form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF -1R that apply to the installation have been met. • I will ensure that a completed,' signed copy of this Installation Certificate shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. I will ensure that all Installation Certificates will come from a HERS provider data reoistry for multiple orientation alternatives, and beginninq October 1, 2010, for all low-rise residential buildings. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) HARRISON ENTERPRISES INC Responsible Person's Name: Responsible Person's Signature: Danielle Garcia Danielle Garcia CSL'B License: 686310 Date Signed: 11/7/2011 position With Company (Title): Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? ❑ Yes ❑ No Reg: 211-A0056607A-M2500001A-0000 Registration Date/Time: 2011/11/30 21:02:49 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 &e),7 HVAC Field Data Sheet Pg l of 2 Client Name job # /I- �YJ--' Date /p" Address 7 5 .y 6s' 4t- e Ph #(%6o U' 5 -6 -Ir- 461�6 2 Technician(s) Permft # ,�� -i t i Gauge/Thermocouple Calibration Date // / - / fllt aclmge I Some Ducts Only I All Ducts Only farele type of work) AiEC l-04 . Eq[dpwent.Data ZONE I ZOAfE Z ZOXE3 ZONE4 System Location or Area Served r=stws, L.Q rZ-.t /3. Heating Equipment Make Cooling Capacity Heating Equipment Model 4 o7v i -3c- ARI Reference Number 3 -Er 8-5 3 Duct Leakage Final Result -d4 M/ton to pass (6%) jjeq!:tipg EquipmentAFUE Duct Location Duct Leakage Final Result <60 CFM/ton to pass (U%) Pass using 60% leakage reduction? Pass using smoke and visual inspection? Duct R -Value (if ducts were in ed) MLa'CF122. 6r.wCH25 -C aft CWAirflow& Paa.fVatlDraw . Heating Load n C/o Heating Equipment Output CapacityPI Condenser Make &w zl-:< Condenser Model Size in Tons 3 SEER & EER /3. Cooling LoadRoo Cooling Capacity 3 & 6b c, : Uf.;20&21 DuctTesdV Duct leakage pretest result 35-3 Duct Leakage Final Result -d4 M/ton to pass (6%) PasslFatl PassIFail Pass(Faff Pas4w Duct Leakage Final Result <60 CFM/ton to pass (U%) Pass using 60% leakage reduction? Pass using smoke and visual inspection? ! Z 6 49ow I Pass1W f MLa'CF122. 6r.wCH25 -C aft CWAirflow& Paa.fVatlDraw . Measured Air Volume from Flow Grid or Hood NEW DUCTS Target 350 CFM/dm a Condenser Tons CHMGEOUT Target 300 CFM/tmn x condenser Tons Measured air greater than Target? (YIN) Measured Fan Watt Draw Target: 0.58 watts/measured CFM = Measured Watts less than Target? (Y/N) Copyrigbt 0 2011 EDS Energy Driven Solrttim hnc HVAC Field Data Sheet Pg 2 of 2 Client Name �L c4 c0' Job # /Z tr- Date //— 2'-1 I • • ALL APPLICABLE BOXES ON TwsFORMMUST BE COMPLETED FOR E4010A NO EREPTIONS; • • CopyrW 0 2011 EDS EawU DAvw Soh dm, hnc. Mffar-ZS Charge &Airflow ZONE 1 ZONE2 ZONE 3 ZONE Condenser Serial Number Supply air dry bulb temperature `Y 8 Return air dry bulb temperature 1 6 Return air wet bulb temperature 5D Evaporator Saturation Temperature 3 Y Condenser Saturation Temperature 6 Suction Line Temperature y Liquid Line Temperature Oa 3 Suction Pressure Liquid Pressure (06 l %3 Actual AmfidwiTei -b perature Spit --- Target Temperature Split from Table RA3.2.3 (�I Passes if difference is t T of Target Temp (Y/N) X Actual SubcooTmg (t 4° of Target tD pass) 3 r Target Subcooiing from Mh. ,Z , Actual Superheat (3 to 26° to pass) Outside air dry bulb temperature 6 MECE126 "Weigh -Lt Qharghw below SS' . Actual Line Set length (ft) Mfr's Standard Line Set Length (ft) Length Difference = Correction Factor (ounces per foot) Target: Correction Factor x Length Difference System Charged to Target? (Y/N) Other Data Minimum amps Maximum amps z 2 ci `� { Breaker size Compressor amps . Return Static Pressure Supply Static Pressure Supply Air Wet Bulb Temperature • • ALL APPLICABLE BOXES ON TwsFORMMUST BE COMPLETED FOR E4010A NO EREPTIONS; • • CopyrW 0 2011 EDS EawU DAvw Soh dm, hnc.