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12-0477 (MECH)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Ta!t 4 -4 Q" BUILDING & SAFETY DEPARTMENT BUILDING PERMIT rte" --7 Application Number:. T2-00000477 -- y Property Address: 81853 RANCHO SANTANA DR APN: '767-200-999-25 312023 - Application description: MECHANICAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 4044 Applicant: A/ Architect or Engineer: 0fpr -------------------------------------------------- LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License Class: C20 License No.: 878533 ate: -aZ— aractor: po-.vers OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: 1 _ 1 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and- who does the work himself or herself through his or her own employees, provided that the improvements are not intended or offered for sale. If, however; the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). (_ 1 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 1 am exempt under Sec. , 8.&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 Owner: DOUG LANG 81853 RANCHO LA QUINTA, CA (760)777-9920 SANTANA DRIVE 92253 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 5/02/12 Contractor: D DIAL ONE'S ONE HOUR A/ HTGMAi 0 2 2012 2712 E. LA CADENA DRIVI RIVERSIDE, CA 92507 (951)276-9744 CITY OF LA QUINTALic. No.: 8.78533 FINANCE DEPT ------------------ 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. 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 CA10001300121 I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, . and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. ate: plicant:U WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. 1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application, the owner, and the applicant, each agrees to, and shall defend, indemnity and hold harmless the City of La Quinta, its officers, agents and employees for anyact or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upon the above-mentioned property for inspection purposes. ate: 215a- nature (Applicant or Agent): v Application Number . . . . . 12-.00000477 Permit . . . MECHANICAL Additional desc . Permit Fee . . . . 31.50 Plan Check Fee 7.88 Issue Date . . . . Valuation . . . 0 Expiration Date 10/29/12 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 16.5000 EA MECH B/C =--------------------------------------------------------------------------- >3-15HP/>100K-500KBTU 16.50 Special Notes and Comments REPLACE 3.5 TON A/C UNIT, CONDENSER, AT SAME LOCATION. 2010 CODES. =---------------------- -------------------------------------- 7 ------ Other Fees . . . . . . . . BLDG STDS ADMIN (SB1473) -------- 1.00 Fee summary Charged Paid Credited - Due ------------------------------------- Permit Fee Total 31.50 -------------------- .00 .00 31.50 Plan Check Total 7.88 .00 .00 7.88 Other Fee Total 1.00 .00 .00 1.00 Grand Total 40.38 .00 .00 40.38 N LQPERMIT Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -IR -ALT -HVAC Climate Zones 10 - 15 Site Address: Enforcement Agency: Date: Permit #: 81853 RANCHO SANTANA DRIVE La Quinta, CA 92253 City of La Quinta Apr 24, 2012 Duct insulation Conditioned Floor Equipment Typel List Minimum Efficiency2 requirement Area Thermostat ❑ Package Unit ❑ Furnace . Indoor Coil .E3- ❑ AFUE ® SEER 13.0 ❑ COP ❑ HSPF ❑ R 6 (CZ 1013) Served by system y ® Setback If not already present, must be ® Condensing Unit ❑ EER ❑ Resistance ❑ R 8 (CZ 14-15) 1400 sf installed) ❑ Other 1. Equipment Type: Choose the equipment being Installed; If more than one system, use another CF -1R -ALT -HVAC for each system. 2. Minimum Equipment Efficiencies: 13 SCER, 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 -411 forms (no hand filled CF-4Rs allowed) are filled out and signed.Beginning October 1, 2010, a registered copy of the CF -1R and CF -6R shall also be on site for final Inspection. ® 1. HVAC Changeout Required Forms: • All HVAC Equipment CF -611 forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS replaced CF -411 forms: MECH-21 and (for split systems) MECH-25 • Condenser Coil and /or CF -611 forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS • Indoor Coil and /or C67 = ms: MECH-21 and (for split systems) MECH-25 • Furnace For Split Systems: Duct I• +; -)ercent; RC, CCA <_ 300 CFM/ton (Minimum_ Air Flow Requirement), TMAH i-pesseRI; Exp: , ---_ �: have been previously sealed and confirmed through HERS verification, or r near feet in unconditioned space, or —I insidated or sealed with asbestos . Cut new - duct', :. equ x�. For ' r e ,' For r .... . 7.' r Required Forms: R »� 4a clUL ig and/or outdo. '+� t CF -611 forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS and/or indoor coil and/, 1r some CF -411 forms: MECH-20 and (for split systems) MECH-25 equipment changed. For Split Systems: Duct leako, percent; RC, CCA > 300 CFM/ton, TMAH For Packaged Units: Dud leakage < 6 percent ❑ 4. New Ducting over 40 feet Required Forms: . Includes adding or replacing more than 40 CF -611 forms: MECH-04, MECH-2I-HERS linear feet of duct in unconditioned space. CF -4R forms: MECH-21 For split system or packaged units: Dud leakage < 15 percent ❑ EXCEPTION: Existing dud 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. • f certify that the energy features and performance specifications for the design Identified on this Certificate of Compliance conform to the requirements of Title 24, Parts 1 and 6 of the California Code of Regulations. • The design features identified on this Certificate of Compliance are consistent with the Information documented on other applicable compliance forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with the permit application. Name: Jim McEllgot Signature: Jim McEligot Company: VENVEST BALLARD INC Date: Apr 24, 2012 Address: 2712 EAST LA CADENA DRIVE License: 878533 City/State/Zip: RIVERSIDE / CA / 92507 Phone: (951) 276-9744 Reg: 212-A0020279A-00000000-0000 Registration Date/Time: 2012/04/24 14:52:28 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms July 2010 J Pa Bin # .. , City of. La Quin'ta 4uik0,& & Safety Division _ P.O. Box 1504,78-495 Calle Tampico La.Quinta, 'CA 92253 - (760) 7'77-7012 Building Permit Application• and Tracking Sheet Permit # ^ a� 1 1 : [ �S 3 o if .. Owner's Name:. (� ,1,� O _ O;sAddress: $L%S�on: fA:- City. ST, zip:�7•�S3 Contractor: 1D Telephone: ` Address: i Project Description:on City, ST, zip: �Ale — _c&aoii e-, oca 17 Telephone: City Lie C Arch Engr., Designer: MIA Address: City, ST, Zip: Telephone: Construction Type:. Occupancy: State Lia #: Project type (eimle one): New Add'n Alter Repair Demo Name of Contact Person: Sq. FL: # Bionics: #Unit$ Telephone # of Contact Penson: Estimated Value of Project: 4 0'I'i .'� o APPLICANT: DO NOT WRITE BELOW THIS UNE # Submittal Req'd Reed TRACEWG PERhIITFF.FS Plan Set Pian Geek submitted. Itrsa Amount Strgdutal Calm Reviewed, ready for corrections Plan Check Deposit. . Truss Cala. Called Contact Person Plan Check Balance • Mde 24 We& Pians picked up Construction Flood plain plan Plans resubmitted." . Mecharilcal Giading plan 2'! Review, ready for corrections/issue Electrical Subeontactor List Called Contact Person Plumbing Grant Deed Pians picked up S.M,L H.O.A. Approval Plans resubmitted Grading IN HOUSE:- ''' Review, ready for correctiondissae Devdoper Impact Fee Planning Approval. Calm Contact Person A T.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-21 Duct Leakage Test — Existing Duct System (Page 1 of 2) Site Address: + 81853 RANCHO SANTANA DRIVE, La Quinta CA 92253 Enforcement Agency: City c La cement AgeQuinta Permit Number: 12-477 (System 1) Enter the Duct System Name or Identification/Tag: System 1 Enter the Duct System Location or Area Served: Whole House Note: Submit one Installation Certificate for each, duct system that must demonstrate compliance in the dwelling. ' r 5 This installation certificate is required for compliance for alterations and additions in existing dwellings to space conditioning systems and duct systems. Note: For existing dwellings, a completely new or replacement duct system can also include existing parts of the original duct system (e.g., register boots, air handler, coil, plenums, etc.) if those parts are accessible and they can be sealed. For a completely new or replacement duct system installed in an existing dwelling, use the Installation Certificate titled "Duct Leakage Test - Completely New or Replacement Duct System. " Duct Leakage Diagnostic Test - existing duct system Select one compliance method from the following four choices. ® 1. Measured leakage less than 15% of fan flow 2. Measured leakage to outside'less.than-10% of Fan Flow 0 3. Reduce leakage by;60% and conduct smoke and fix all leaks - i7 4.°Fix all accessible leaks using. smoke and HERS rater verify �. Note: (One of -Options: 1, 2, or 3 must be kttempted.,before utilizing, Option 4.), Determine/nominal Fan Flow using one o�frthe following three calculationmethods.0r,. 4•„t . ✓ ® Cooling system of ' f Y x 400�s : method Size condenser in Tons .13-.5 1400 CFM i Output V Heing system method:21.7 x Capacy i usantlsxo B hr =� CFM 1 ✓ Measured system aiiFlow.using'RA3.3 airfloesprocedure:`�=G CFM— ' '12 Option 1 used then:.. Allowed leakage - Fan Flow 1400' x,0 15!=, -1230 CFML , 1 Actual Leakage'= 119 CFM •. Pass if Leakage Actual is less than Allowed Pass Fail Option 2 used then:' _ •. 2 Allowed leakage = Fan:Flow _ x 0.10 = _CFM f Actual. Leakage to outside ,= '- CFM Pass if Leakage Actual is less than Allowed 0 Pass Fail, Option 3 used then: Initial leakage priortostart of work = _ CFM Final leakage after sealing all accessible leaks using smoke test = _ CFM 3 Initial leakage _ - Final leakage _ = Leakage reduction . CFM ((Leakage reduction _ / Initial leakage _) x 100% _ % Reduction , Pass if % Reduction >= 60% Pass Fail Option 4 used then: 4 All accessible leaks repaired using smoke test. HERS rater must verify (No sampling). Pass if all accessible leaks have been repaired using smoke 6 Pass E3 Fail Reg: 212-A0020279A-M2100001A-M21A'•Registration Date/Time: 2012/11/26 12:18:54 , HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 ® 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. ® All supply and return register'boots must be,isealed to the'drywall if, smoke testzedis utilifor, compliance - applies'to'duct leakage compliance option 3'(leakage reduction'by 60%) and option 4%fix all accessible t leaks) described above. f�`' %_ w • ® New duct installations.cannot,utilize buildingduc N cavities asiplenums or platform returns in.lieu of ts �-"�.. �Zr�.4..,'�0�',�.. .'v''��"'+•.e' 'v..aeY 14-> .r,.: ._-' ® Mastic and draw bands must be used in combination With `'cloth rubber. adhesive duct tape to seal leaks at all new duct `connections Y r ' DECLARATION STATEMENT,- . TATEMENT, . I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. ' . I am the certified HERS rater who performed the verification services identified and reported on this certificate (responsible rater). - The installed feature, material, component, or manufactured device requiring HERS verification that is identified on'this certificate (the installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified - on the Certificate(s) of Compliance (CF -111) approved by the local enforcement agency. The information reported on applicable sections of the Installation Certificate(s) (CF76R), 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) CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-21 VENVEST BALLARD INC Duct Leakage Test - Existing Duct System (Page 2 of 2) CSLB License: aim McEligot Site Address: 81853 RANCHO SANTANA DRIVE, La Quinta CA 92253 Enforcement Agency: Permit Number: ®tested/verified dwelling (System 1) City'of La Quinta 112-477 HERS sample group ® 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. ® All supply and return register'boots must be,isealed to the'drywall if, smoke testzedis utilifor, compliance - applies'to'duct leakage compliance option 3'(leakage reduction'by 60%) and option 4%fix all accessible t leaks) described above. f�`' %_ w • ® New duct installations.cannot,utilize buildingduc N cavities asiplenums or platform returns in.lieu of ts �-"�.. �Zr�.4..,'�0�',�.. .'v''��"'+•.e' 'v..aeY 14-> .r,.: ._-' ® Mastic and draw bands must be used in combination With `'cloth rubber. adhesive duct tape to seal leaks at all new duct `connections Y r ' DECLARATION STATEMENT,- . TATEMENT, . I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. ' . I am the certified HERS rater who performed the verification services identified and reported on this certificate (responsible rater). - The installed feature, material, component, or manufactured device requiring HERS verification that is identified on'this certificate (the installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified - on the Certificate(s) of Compliance (CF -111) approved by the local enforcement agency. The information reported on applicable sections of the Installation Certificate(s) (CF76R), 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) , VENVEST BALLARD INC Responsible Person's Name: w CSLB License: aim McEligot 878533 HERS Provider Data Registry Information Sample Group # (if applicable): N/A ®tested/verified dwelling ❑ not-tested/verified dwelling in 1ja HERS sample group HERS Rater Information CaICERTS Certificate # CCl-1798649534 ' HERS Rater Company Name: ; Athens Air Responsible Rater's Name: Responsible Rater's Signature: Andrew Pulos Andrew Pulos _ Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 11_/24/2012 CC2004503 • �- - Reg: 212-A0020279A-M2100001A-M21A Registration Date/Time: 2012/11/26 12:18:59 •HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 T CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-25 Refrigerant Charge Verification = Standard Measurement Procedure (Page 1 of 5) Site Address: Enforcement Agency: Permit Number: 81853 RANCHO SANTANA DRIVE, La Quinta CA 922531 City of La Quinta 12-477 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 I • System 1 System Location or Area Served I.Whole House 1 ® Yes ❑ No 5/16 inch (8 mm) access hole upstream of evaporative coil in the return plenum and labeled according to Figure in Section RA3.2.2.2.2. 2 ® 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 - Serisor,on-the Evaporator Coil System Name or Identification/Tag j r .11.r System 1 ' 1' k " �, f it i 3 ❑ Yes' No The sensor is factory installed, or�field installed according to manufacturer's specifications, or is'installed by methods/specifications approved by the Executive ❑ Yes ❑ No /❑ j / Director. 1 Il li J f't t� � The sensor wire is terminated with a standard mini plug suitable for connection to a' 4 ,' '❑ Yes ., ❑.No , digital thefmometer..The sensor mini plug is accessible to the installing:;ted nician r and,the HERS rater without changing the airflow through the condenser coil ' 5 = ❑Yes [3 No When attached to a digital thermometer, the sensor provides an indication of the + 9 saturation temperature of the coil. Yes to 3, 4, and 5 is a pass. Enter N/A if STMS are not ® N/A ✓ ❑ Pass ✓ ❑ Fail applicable. Otherwise enter Pass or Fail I✓ STMS - Sensor on the Condenser Coil System Name or Identification/Tag I System 1 t . 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 ✓ ❑ Pass ✓ ❑ Fail applicable. Otherwise enter Pass or Fail Reg: 212-A0020279A-M2500001A-M25A Registration Date/Time:.2012/11/26 12:21:16 HERS Provider: CalCERTS, Inc.. 2008 Residential Compliance Forms ' March 2010 t . t � Reg: 212-A0020279A-M2500001A-M25A Registration Date/Time:.2012/11/26 12:21:16 HERS Provider: CalCERTS, Inc.. 2008 Residential Compliance Forms ' March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-25 h, Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5) Site Address: Enforcement Agency: Permit Number: 81853 RANCHO SANTANA DRIVE, La Quinta CA 922531 City of La Quinta 12-477 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 system's In the dwelling can be documented for compliance using this form. Attach an additional form(s) for any additional systems in the dwelling as applicable. • The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure, • The system must meet minimum airflow requirements as prerequisite for a valid refrigerant charge test. • If outdoor air dry-bulb is 55°F or below, the installer must use the Alternate Charge Measurement Procedure, Space Conditioning Systems System Name or Identification/Tag System 1 - (must be re -calibrated monthly) System Location or Area Served r Whole House 11/1/2012.s+ :. ',}j 1F (must be re-celibra.ted monthly) Outdoor Unit Serial # 1204687444 -^- Outdoor Unit Make Goodman - Outdoor Unit Model GSC130421 " Nominal Cooling Capacity Btu/hr,'t 42000 ,, . . 56 Date of Verification x 11/24/2012 Calibration of Diagnostic Instruments Date of Refrigerant Gauge Calibration 11/1/2012 (must be re -calibrated monthly) Date of Thermocou le Calibrationt" p 11/1/2012.s+ :. ',}j 1F (must be re-celibra.ted monthly) Supply. (evaporator leavin air dry-bulb I Y 60 Measured. Temperatures`(`F)''di. 4 ` :..: 7 11, it �¢ f j :-: System Name or Identification/Tag rY System 1 Supply. (evaporator leavin air dry-bulb I Y 60 -^- temperature (Tsu I Y. db) , PP - Return (evaporator entering) air dry-bulb~ 75 " temperature (Treturn, db) Return (evaporator entering) air wet -bulb 56 temperature (Treturn, wb) `. r ` Evaporator saturation temperature 35 35 (T sat) Condensor saturation temperature 90 (Tcondensor, sat) Suction line temperature (Tsuction) 50 Liquid Line Temperature (Tliquid) 79' Condenser (entering) air dry-bulb 86 temperature (Tcondenser, db) f F ' Reg: 212-A0020279A-M2500001A-M25A Registration Date/Time:.2012/11/26 12:21:16 HERS Provider: CalCERTS, Inc. -2008 Residential °Compliance•Forms _ ' March 2010 t INSTALLATION CERTIFICATE CF-411-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5) Site Address: Enforcement Agency: Permit Number:. 81853 RANCHO SANTANA-DRIVE, La Quinta CA 92253 City of La Quinta 12-477 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, 15.00 db - Tsupply, db ` Target Temperature Split from Table RA3.2-3 20.4 _ using Treturn, Wb and Treturn, db } Calculate difference: Actual Temperature Split - -5.4 Target Temperature Split = Passes if difference is between -4°F and +4°F or, _ upon remeasurement, if between -4°F and PASS -100°F Enter Pass or Fail Note: Temperature Split Method Calculation is not necessary if actual Cooling Coil Airflow is verified using one of the airflow measurement procedures specified in Reference Residential Appendix RA3.3. If actual cooling coil airflow is measured, the value. must be equal to or greater than the Calculated Minimum Airflow Requirement in the table below. Calculated. Mini mum` Airflow Requirement (CFM), = Nominal Cooling Capacity (ton) X 300 (cfm/ton) System Name or Identffication/Tag Calculated Minimum Airflow Requirement (CFM) Measured Airflow; ng RA3 3 procedures (CFM) Passes if measured airflow is greater than or equal to the calculated_ minimum airflow f requirement.",. Enter Pass or Fail Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for fixed orifice metering device systems System Name or Identification/Tag'• Calculate: Actual Superheat = Tsuction - Tevaporator, sat Target Superheat from Table RA3.2-2 using Treturn, wb and Tcondenser, db } Calculate difference: Actual Superheat - Target Superheat System passes if difference is between -6°F and _ +6°F Enter Pass or Fail Reg: 212-A0020279A-M2500001A-M25A Registration Date/Time: 2012/11/26 12:21:16 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: 81853 RANCHO SANTANA DRIVE, La. Quinta CA 922531 City of La Quinta 12-477 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 • i ' INSTALLATION CERTIFICATE CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5) Site Address:- Enforcement Agency: Permit Number: 81853 RANCHO SANTANA DRIVE, La. Quinta CA 922531 City of La Quinta 12-477 Subcooling Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. - System Name or Identification/Tag System 1 Calculate: Actual Subcooling = 11.0 Tcondenser, sat - Tliquid Target Subcooling specified by manufacturer' 10 Calculate difference: 1 Actual Subcooling - Target Subcooling = System passes if difference is between _ -4°F and +4°F PASS ' +` Enter Pass or Fail Metering Device Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag System 1 Calculate: Actual Superheat,= 15.0 Tsuction - Tevaporator,'sat Enter allowable superheat range from manufacturer's specifications (or use range 15 between 3°F and 26°F if manufacturer's specification is not available) _ System passes if actual superheat is within the allowable.superheat range F ; "PASS ' +` T fwEnter Pass or Fail. Reg: 212-A0020279A-M2500001A-M25A Registration Date/Time: 2012/11/26 12:21:16 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance'Forms)' F March 2010 INSTALLATION CERTIFICATE CF-4111=MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5) Site Address: Enforcement Agency: Permit Number: 81853 RANCHO SANTANA DRIVE, La Quinta CA 922531 City of La Quinta 12-477 9 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'l 1878533 HERS Provider Data Registry Information . Sample Group # (if applicable): N/A System meets all refrigerant charge and airflow ❑ not-tested/verified dwelling in la HERS sample group requirements. PASS Athens Air Responsible Rater's Name: Responsible Rater's Signature:, Enter Pass or Fail Andrew Pulos Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 11/24/2012 CC2004503 1 . ter. 'R».+ '� • * � a .r • • DECLARATION STATEMENT . I certify under penalty of perjury, under, the laws of the State of California, the information provided on this form is true and correct. . I am the certified HERS rater who performed the verification services identified and reported on this certificate (responsible rater). . The Installed feature, material, component, or manufactured device requiring HERS verification that is identified on this certificate (the installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified on the Certificate(s) of Compliance (CF -111) approved by the local enforcement agency. t . 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 -SR) approved by the enforcement agency. i _ - Builder or Installer information as shown on the Installation Certificate (CF -6111) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) VENVEST BALLARD INC Responsible Person's Name: CSLB License: , Jim McEligot 1878533 HERS Provider Data Registry Information . Sample Group # (if applicable): N/A ® tested/verified dwelling ❑ not-tested/verified dwelling in la HERS sample group HERS Rater Information CalCERTS Certificate # CC1-1798649534 HERS Rater Company Name: Athens Air Responsible Rater's Name: Responsible Rater's Signature:, Andrew Pulos Andrew Pulos Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 11/24/2012 CC2004503 Reg: 212-A0020279A-M2500001A-M25A Registration Date/Time: 2012/11/26 12:21:16 'HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms c _ March 2010 Space Conditioning Systems Heating Equipment - Equip Type (package- heat pump) INSTALLATION CERTIFICATE CF-6R-MECH-04 ARI Reference Number2 # of Identical Systems Space Conditioning Systems, Ducts and Fans (Page 1 of 2) Duct Location (attic, crawl- space, etc.) Duct R -value Site Address: 81853 RANCHO SANTANA DRIVE, La Quinta CA 92253 Enforcement Agency: Permit Number: (System 1) r City of La Quinta 12-477 Space Conditioning Systems Heating Equipment - Equip Type (package- heat pump) 4 CEC Certified Mfr. Name and Model Number ARI Reference Number2 # of Identical Systems Efficiency (AFUE, etc.)1, 3 (>=CF -1R value)4 Duct Location (attic, crawl- space, etc.) Duct R -value Heating Load (kBtu/hr) Heating Capacity (kBtu/hr) Equip (SEER Location Type f' and EER) (attic, (package • ARI # of 1, 3 crawl- Cooling Cooling :heat "CEC Certified Mfr. Name Reference Identical (>=CF -1R space, Duct Load' Capacity pump) `i and Model Number Number2 Systems value)4 etc.) R -value (kBtu/hr) (kBtu/hr) Split A/C Goodman :0GSC130421 : -: .L" fl 13`SEER Attic" �� -2i � 3.5 Tons Cooling Equipment , I i-- , Efficiency Duct Equip (SEER Location Type f' and EER) (attic, (package • ARI # of 1, 3 crawl- Cooling Cooling :heat "CEC Certified Mfr. Name Reference Identical (>=CF -1R space, Duct Load' Capacity pump) `i and Model Number Number2 Systems value)4 etc.) R -value (kBtu/hr) (kBtu/hr) Split A/C Goodman :0GSC130421 : -: .L" fl 13`SEER Attic" �� -2i � 3.5 Tons ! it. ,- [�, 1. If project is new construction, see Footnotes to Standards Table 151-B and Table 151-C for duct ceiling alternative compliance. 2. ARI Reference Number can be found by entering the equipment model number at http://www. aridirectory. org/ari/ac. ptip# 3. Listed efficiency on this page must be greater than or equal ( ? ) to the value shown on the CF -IR form. . 4. When CF -IR is reference it is also applicable to the CF -IR, CF -IR -AA or CF -IR -ALT ALL BOXES MUST BE CHECKED TO BE A VALID FORM ® §110-§113: HVAC equipment is certified by the California Energy Commission. ® §150(h): Heating and/or cooling loads calculated in accordance with ASHRAE, SMACNA,-or ACCA. ® §150(i):'Setback Thermostat on all applicable heating and/or cooling systems meet the requirements of §112(c). ' - 'S §150(j)2: Pipe insulation for cooling system refrigerant suction, chilled water and brine lines meets minimum requirements of Table 150-B and includes a vapor retardant or is enclosed entirely in " conditioned space. , is t i Reg: 212-A0020279A-M0400001A-0000 Registration Date/Time: 2012/11/26 12:10:27 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6111-MECH-0 Space Conditioning Systems, Ducts and Fans (Page 2 of 2) Site Address: 81853 RANCHO SANTANA DRIVE, La Quinta CA 92253 Enforcement Agency: Permit Number: (System 1) City of La Quinta 12-477 Ducts and Fans §150(m): Duct and.Fans T ® 1. All air -distribution system ducts and plenums installed, sealed and insulated to meet the requirements of CMC Sections 601, 602, 603, 604, 605 and Standard 6 -5; -supply -air and return -air ducts and plenums are insulated to a minimum installed level of R-4.2 or enclosed entirely in conditioned space. Openings shall be sealed with mastic, tape or other duct -closure system that meets the applicable requirements of UL 181, UL 181A, or UL 1818 or aerosol sealant that meets the requirements of UL 723. If mastic or tape is used to seal openings greater than 1/4 inch, the combination of mastic and either mesh or tape shall be used; and ® 1. Building cavities, support platforms for air handlers, and plenums defined or constructed.Oith materials other than sealed sheet metal, duct board or flexible duct shall not be used for conveying , conditioned air. Building cavities and support platforms may contain ducts. Ducts installed in cavities and support platforms shall not be compressed to cause reductions in the cross-sectional area of the ducts. IN 2D. Joints and seams of duct systems and their components shall not be sealed with cloth back rubber adhesive duct tapes unless such tape is used in combination with mastic and draw bands. ® 7. Exhaust fan systems have back draft or automatic dampers. .1818. Gravity ventilating systems serving conditioned space have either automatic or readily accessible, manually operated dampers. ® Protection of Insulation•.Insulation shall be protected from damage, including that due to sunlight, moisture, equipment maintenance, and wind: Cellular foam insulation shall be protected as above or ,painted with a;coating that is water retardant and provides shielding from solar radiation that can cause .'degradation of the material. 181-10. Flexible ducts cannot have porousTinner, cores p t DECLARATION STATEMENT . Icertify 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 reviewed a copy of the Certificate of Compliance (CF -111) form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF -111 that apply to the installation have been meta • 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 occuoancv. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) - VENVEST BALLARD INC dba DIAL ONE'S ONE HOUR AIR CONDITIONING AND HEATING Responsible Person's Name: Responsible Person's Signature: Ruth Debrick Ruth Debrick CSLB License: 878533 Date Signed: 4/20/2012 Position With Company (Title): Reg: 212-A0020279A-M0400001A-0000 Registration Date/Time: 2012/11/26 12:10:27 HERS Provider: CalCERTS, Inc. . 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS Duct Leakage Test — Existing Duct System (Page 1 of 2) Site Address: 81853 RANCHO SANTANA DRIVE, La Quinta CA 92253 Enforcement Agency: Permit Number: (System 1) City of La Quinta 12-477 Enter the Duct System Name or Identification/Tag: System 1 Enter the Duct System Location or Area Served: Whole House Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the dwelling. stallation certificate is required for compliance for alterations and additions in existing dwellings to :onditioning 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 - existinq duct system Select one compliance method from the following four choices. ® 1. Measured leakage less than 15% of fan flow 02. Measured leakage to outside less than 10% of Fan Flow ` 133. Reduce leakage by 60% and'conduct smoke and fix all leaks , ❑ 4. Fix all accessible leaks using smoke and HERS rater verify Note:'(One of Options_ 1; 2 or 3 must be attempted,befoce utilizing,Option 4.)__ Determine nominal Fan Flow using one of the following three calculation methods.'= t ✓ ® Cooling system method: Size of condenser.in Tons f 3.5 x'400 — ^' 1400 CFM .`<, . - I,�� t ✓ _ ❑Heating system method: 21:7 x Output Capacity in Thousands of Btu/hr = CFM A ✓ ❑ Measured system airflow using RA3.3 airflow -test procedures: ` CFM; "t, ,.; " - i' ' j 1 Option 1 used then: ;� Allowed leakage = Fan Airflow' 1400 x 0.15 - 210 CFM.` Actual Leakage _ 119 CFM Pass if Actual Leakage is less than Allowed leakage Pass Fail Option 2 used then: 2 Allowed leakage =jFan Airflow _ x 0.10 = _ CFM Actual Leakage to outside = CFM Pass if Actual leakage to outside is less than Allowed leakage Pass Fail Option 3 used then: - Initial leakage prior to start of work = CFM Final leakage after sealing all accessible leaks using smoke test = _ CFM 3 Initial leakage _ - Final leakage _ = Leakage reduction _ CFM ((Leakage reduction _/ Initial leakage x 100% _ " % Reduction .r _ Pass if % Reduction >= 60% Pass Fail Option 4 used then: , 4 All accessible leaks repaired using smoke test. HERS rater must verify (No Sampling). • Pass if all accessible leaks have been repaired using smoke Pass Fail Reg: 212-A0020279A-M2100001A-0000 Registration Date/Time: 2012/11/26 12:11:05 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms f ` March 2010 INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS Duct Leakage Test - Existing Duct System (Page 2 of 2) Site Address: 81853 RANCHO SANTANA DRIVE, La Quinta CA 92253 Enforcement Agency: Permit Number:. (System 1) City of La Quinta -12-477 , ivy ® 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., ® All supply and return register'tioots4mustbe�sealed to the drywall if,smoke testis utilized forrcompliance - appliesfto duct leakage compliance option 3 (leakage' reduction by 60%) and option 4,(fix all accessible leaks) described above' " "- ® New.duct installatlons,cannot utillze'building cavities as plenums..or platform retiirns,m lieu of ducts:, ® Mastic and draw bands must be used m combination with cloth backed rubber -adhesive duct tape to seal leaks at -all new duct -'connections ' ` DECLARATION STATEMENT l i . 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 -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 { registry for multiple orientation alternatives, and beginning October 1, 2010, for all low-rise residential buildings.. • 878533 4/20/2012 Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) VENVEST BALLARD INC dba DIAL ONE'S ONE HOUR AIR CONDITIONING AND HEATING Responsible Person's Name: Responsible Person's Signature: Ruth Debrick • Ruth Debrick - CSLB License: Date Signed: - Position With Company (Title): Is this installation monitored by a Third Party Quality Name of TPQCP,(if applicable): Control Program (TPQCP)? [3 Yes (3 Reg: 212-A0020279A-M2100001A-0000 Registration Date/Time: 2012/11/26 12:11:05_ HERS Provider: Ca10ERTS, Inc. 2008 Residential,Compliance Forms I, March 2010 No • • 878533 4/20/2012 Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) VENVEST BALLARD INC dba DIAL ONE'S ONE HOUR AIR CONDITIONING AND HEATING Responsible Person's Name: Responsible Person's Signature: Ruth Debrick • Ruth Debrick - CSLB License: Date Signed: - Position With Company (Title): Is this installation monitored by a Third Party Quality Name of TPQCP,(if applicable): Control Program (TPQCP)? [3 Yes (3 Reg: 212-A0020279A-M2100001A-0000 Registration Date/Time: 2012/11/26 12:11:05_ HERS Provider: Ca10ERTS, Inc. 2008 Residential,Compliance Forms I, March 2010 INSTALLATION CERTIFICATE* CF-611-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 5) Site Address: I Enforcement Agency: Permit Number: 81853 RANCHO SANTANA DRIVE, La Quinta CA 922531 City of La Quint a 12-477 Note: If installation of a Charge Indicator Display (CID) is utilized as an alternative to refrigerant charge verification for compliance, a MECH-24 Certificate (instead of this MECH-25 Certificate) should be used to demonstrate compliance with the refrigerant charge verification requirement. TMAH and STMS are not required for compliance, when a CID is utilized for compliance. As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional form(s) for any additional systems in the dwelling as applicable. Temperature Measurement Access Holes (TMAH) and Saturation Temperature Measurement Sensors (STMS) Procedures for installing TMAH are specified in Reference Residential Appendix RA3.2. If refrigerant charge verification is required for compliance, TMAH are also required for compliance. STMS are only required for completely new or replacement space -conditioning systems that utilize prescriptive compliance method. TMAH -Access Holes in Supply and Return Plenums of Air Handler System Name or Identification/Tag System 1 System Location or Area Served Whole House 1 ® Yes ❑ No 5/16 inch (8 mm) access hole upstream of evaporative coil in the return plenum and labeled according to Figure in Section RA3.2.2.2.2. 2 ® Yes ❑ No 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 on.the Evaporator Coil System Name olir Identification/Tagl3 ;. � ,r System 1 3 The sensor is factory installed, or field installed according to manufacturer's The sensor is factory installed, or field installed according to manufacturer's specifications, methods/specifications ❑ Yes [13yes ❑No or is'installed by approved by the Executive Director. Director. 4 Yes 7 r No -' The sensor wire is terminated with a standard mini plug suitable for connection to a;' digital ❑ Yes ❑ !"% ❑ thermometer. The sensor mini plug is accessible to<the installing technician and the HERS rater without changing the airflow through the condenser coil and the HERS rater without changing the airflow through the condenser coif 5 ❑ Yes ❑ No The sensor measures the saturation temperature of the coil within 1.3 degrees F Yes to 3, 4, and 5 is a pass. Enter N/A if STMS are not applicable. Otherwise enter Pass or Fail V ®N/A ✓ [3 Pas ✓ ❑Fail STMS - Sensor on the Condenser Coil System Name or Identification/Tag System 1 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 I ❑ No IThe 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 T ✓ ® N/A ✓ ❑ Pass ✓ [3Fail applicable. Otherwise enter Pass or Fail A Reg: 212-A0020279A-M2500001A-0000 Registration Date/Time: 2012/11/26 12:17:26 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 Standard Charge Measurement Procedure (for use if outdoor air dry-bulb is above 55°F) Procedures for determining Refrigerant Charge using the Standard Charge Measurement Procedure are available in Reference Residential. Appendix RA3.2. As many as 4 systems in the dwelling -can be documented for compliance using this form. Attach an additional form(s) for any additional systems in the dwelling as applicable. . • The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure. • The system must meet minimum airflow requirements as prerequisite for a valid refrigerant charge test. +, • If outdoor air dry-bulb is 55°F or below, the installer must use the Alternate Charge Measurement Procedure. Space Conditioning Systems + System Name or Identification/Tag System 1 (must be re -calibrated monthly) Date of}Thefmocou le Calibration y 4/1/2012 `'• System Location or Area Served Whole House r 4 1204687444 � ^•�"� v W- ��• w ,3 _ . ;�• . temperature (T t ) ' a supply, db . Standard Charge Measurement Procedure (for use if outdoor air dry-bulb is above 55°F) Procedures for determining Refrigerant Charge using the Standard Charge Measurement Procedure are available in Reference Residential. Appendix RA3.2. As many as 4 systems in the dwelling -can be documented for compliance using this form. Attach an additional form(s) for any additional systems in the dwelling as applicable. . • The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure. • The system must meet minimum airflow requirements as prerequisite for a valid refrigerant charge test. +, • If outdoor air dry-bulb is 55°F or below, the installer must use the Alternate Charge Measurement Procedure. Space Conditioning Systems + System Name or Identification/Tag System 1 (must be re -calibrated monthly) Date of}Thefmocou le Calibration y 4/1/2012 `'• System Location or Area Served Whole House r Outdoor Unit Serial #," 1204687444 � ^•�"� v W- ��• w ,3 _ . ;�• . temperature (T t ) ' a supply, db . T 62 ` Outdoor Unit Make goodman' temperature(Treturn, db) • Outdoor Unit Model GSC130421 Nominal Cooling Capacity Btu/h 42000 Date of Verification ` * ;y, ' -- .. 4/20/2012 (Tevaporator, sat) Calibration of.Diagnostic Instruments Date of Refrigerant Gauge Calibration ., `:. 4/1/2012 _ (must be re -calibrated monthly) Date of}Thefmocou le Calibration y 4/1/2012 `'• (must be re -calibrated monthly) Measured Temperatures, °F _• ; €. _- — .: System Name or Identification/Tag `. p' 3 {System 1E 'ye Supply.(evaporatorleaving) air dry-bulb ."� - . � ^•�"� v W- ��• w ,3 _ . ;�• . temperature (T t ) ' a supply, db . T 62 + Return (evaporator entering) air.dry-bulb' 78 temperature(Treturn, db) • Return (evaporator entering) air wet -bulb t 55 temperature (Treturn, wb) a • # Evaporator saturation temperature 34 (Tevaporator, sat) Condensor saturation temperature ` 92 r (Tcondensor, sat) L Suction line temperature (Tsuction) , 50 Liquid Line Temperature (Tliquid) 79 Condenser (entering) air dry-bulb 85 temperature (Tcondenser, db) Reg: 212-A0020279A-M2500001A-0000. Registration Date/Time: 2012/11/26 12:17:26 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms `' , August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5) Site Address: I I Enforcement Agency: Permit Number: 81853 RANCHO SANTANA DRIVE, La Quinta CA 92253 City of La Quint a 12-477 Minimum Airflow Requirement .'/ . r 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, '16.00 db - Tsupply, db ' Target Temperature Split from Table RA3.2-3 24.2 using Treturn, wb and Treturn, db • Calculate difference: Actual Temperature Split - -8.2 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 Split Method Calculation is not necessary if actual Cooling Coil Airflow is verified using one of the airflow measurement procedures specified in Reference Residential Appendix RA3.3. If actual cooling coil airflow is measured, the value must be equal to,'or greater than the Calculated Minimum Airflow Requirement in the table below. Calculated Minimum Airflow Requirement (CFM) = Nominal -Cooling Capacity (ton) X 300 (cfm/ton) System Name or Idenbfication/Tag4 System Calculated Minimum Airflow Requirement (CFM) g. •y ..J �.i1` ! (. T E00 y}y j Measured Ai�rfl�.usingRRA3� 3nprocedures (CFM) - �.n Passes if measured airflow is greater than or equal to the calculated minimum airflow: . • ;'` _ ; •. requirement.— . r g ' Enter Pass or Fail Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for fixed orifice metering device systems System Name or Identification/Tag' : System.1 Calculate: Actual Superheat = Tsuction - Tevaporator,'sat ' Target Superheat from Table RA3.2-2 using.. Treturn, wb and Tcondenser, db ' Calculate difference: Actual Superheat - Target Superheat = System passes if difference is between -5°F and , +5°F iEnter Pass or Fail e Reg: 212-A0020279A-M2500001A-0000 'Registration Date/Time: 2012/11/26 12:17:26 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forma t.` 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: 81853 RANCHO SANTANA DRIVE, La Quinta CA 922531 City of La Quinta 12-477 Subcooling Charge Method Calculations for.Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag System 1 ' Calculate: Actual Subcooling = = 13.0 Tcondenser, sat - Tliquid Target Subcooling specified by manufacturer 10 Calculate difference: 3 Actual Subcooling - Target Subcooling = System passes if difference is between ` -3°F and +3°F PASS i" Enter Pass or Fail Metering Device Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag System 1 ' Calculate: Actual Superheat 16.0 Tsuction - Tevaporator, sat , " i Enter allowable superheat range from manufacturer's specifications (or use range 16 between 40F and 25°F if manufacturer's specification is not available) ` System passes.if a ctual'superheat is within the allowable superheat range //f --j j► PAS' p'• i" ,! t Enter, Pass or; Fai ' _ f , rE � • Sl{, � M e jJj rEy �!. � }i } Y� ? 9«:. " .. ' a r r Reg: 212-A0020279A-M2500001A-0000 Registration Date/Time: 2012/11/26 12:17:26 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms , August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 5'of 5) Site Address: Enforcement Agency: Permit Number: 81853 RANCHO SANTANA DRIVE, La Quinta CA 92253 City of La Quinta 12-477 Standard Charge Measurement Summary: System shall pass both refrigerant charge criteria, metering device criteria (if applicable), and minimum cooling coil airflow criteria based on measurements taken concurrently during system operation. If corrective actions were taken, all applicable verification criteria must be re -measured and/or recalculated. System Name or Identification/Tag System 1 CSLB License: 878533 [Date Signed: 4/20/2012 position With Company (Title): System meets all refrigerant charge and airflow Name of TPQCP (if applicable): Control Program (TPQCP)? - [3 Yes ❑ No ^ requirements. PASS Enter Pass or Fail .4.44 „y,... 47 r . 40, DECLARATION STATEMENT -. . I certify under penaltyof pe6ury, 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 -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 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) VENVEST BALLARD INC dba DIAL ONE'S ONE HOUR AIR CONDITIONING AND HEATING Responsible Person's Name: Responsible Person's Signature: Ruth Debrick Ruth Debrick CSLB License: 878533 [Date Signed: 4/20/2012 position With Company (Title): Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? - [3 Yes ❑ No ^ Reg: 212-A0020279A-M2500001A-0000 Registration Date/Time: 2012/11/26 12:17:26 HERS Provider: C_a10ERTS, Inc. 2008 Residential Compliance Forms . August 2009