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11-1220 (MECH)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: _ _r 11=00001220' ' Property Address: ---4-8.617 PASEO TARAZO APN: 646 -082 -009 - Application description: MECHANICAL Property Zoning: LOW DENSITY RESIDENTI2 Application valuation: 6700 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT MPP11U0nL. MI U1 111."L VI urymccl. \n - ------------------------------------=------- 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 Prof ppnals Code,�DSLmy License is in full force and effect. License,Classi C20 C36 � / License0o..J827420 - VWNCM-rlVlLULK ULL.LMKMI IVN. I hereby affirm under penalty of perjury that I am exempt from the -Contractor's State License La he 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).: (_) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon,. and who does the work himself or herself through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). (_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractors) licensed pursuant to the Contractors' State License Law.). (_) I am exempt under Sec. , B.&P.C. for this reason . - CONSTRUCTION LENDING AGENCY 1 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.). - LQPERMIT Owner: ROBERT LIPTAY 48617 PASEO TARAZO UNKNOWN, CA 99999 Contractor: ALL SEASONS A/C, P.O. BOX 1112 PALM DESERT, CA (760)568-2663 Lic. No.: 827420 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7.153 Date: 11/09/11 -------------------------------------------------- WORKER'S COMPENSATION DECLARATION . 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 NORGUARD " INS Policy Number ALWC124752 _ I certify that, in the performance of the woik for which'this permit is issued,. ) 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 showcome subiegA&Ihe worke ' co ensation provisions of Section WARNING: FAILAIRE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLA , AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONERUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT - IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. 1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a -result of this application, the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or.omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not co enced within 180 days from date of issuance of such permit, or cessation of work for 1 days 'll subject permit to cancellation. I certify that I have read this application and state that the ab rmation is ply with all city and county ordinances and state laws relating to but g const ction, a her auth ize r resentatives of this county jb enter upon the above-mentioned pro rty for insp ction p po , Application.Number . . . . . 11-00001220 Permit . . . MECHANICAL Additional desc . Permit Fee . . 40.50 Plan Check Fee 10.13 Issue Date Valuation 0 Expiration Date 5/07/12 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 9.0000 EA MECH FURNACE <=100K 9.00 1.00 1b.5000 EA M8CH B/C >j-15HY%>100K-5001(i'1'U 16.50 ---------------------------------------------------------------------------- Special Notes and Comments HVAC CHANGE -OUT, NEW FURNACE, INDOOR COIL & CONDENSING UNIT. 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 Simplified. Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-IR-ALT-HVAC Climate Zones 10 - 15 Site Address: Enforcement Agency: Date: Permit #: 48617 Paseo Tarazo La Quinta, CA 92253 City of La Quinta Nov 7, 2011 Duct insulation Conditioned Floor Equipment Type1 List Minimum Efficiency2 requirement Area Thermostat ❑ Package Unit p Furnace R AFUE _Z§ycL. ❑ COP ❑ R 6 PCZ 10-13) Served by system 0 Setback • Indoor Coil E5 SEER 13.0 ❑ HSPF ❑ R 8 (CZ 14-15) 1600 sf If not already present, must be ® Condensing Unit ❑ EER ❑ Resistance installed) ❑ Other 1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF-IR-ALT-HVAC for each system. 2. Minimum 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 tie forms shall be left on site for final inspection and a copy given to the homeowner. At final, the inspector verifies that the work I sted 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 o- the CF-1R and CF-6R shall also be on site for final inspection. D 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-4R forms: MECH-21 and (for split systems) MECH-25' . Condenser Coil and /or CF-6R forms: MECH-04, 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 :5 300 CFM/ton (Minimum Air Flow Requirement), TMAH Exempted from duct leakage testing if: ❑ 1. Duct system was documented to have been previously sealed and confirmed through HERS verification, or ❑ 2. Duct systems with less than 40 linear feet in unconditioned space, or ❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos ❑ 4. Theysystem.will not be Ducted (iec—tless.Mini-Split_System)(-Also.Exempt�from Refrigera�nt�C-harge) ❑ 2. NewLHVAC System Required Forms: @`='` Y.. , .Cut inyor Changeout with A' k4',-X ' :r f Ate' y :e CF, 6R forms -MECH-04 MECH 2O;.HERS tan'd'(for�split system"s) MECH 22 HERS, and new ducts: (all new ' ducting and all new . MECHk25cHER5 btuK t . CF-411 forrris,�MECH 20 ' equipment) and (for split systems) MECH-22and MECH-25 +#f/I ` .. a Vii' .--4r__1 x .. ,I. �. ,1k For Split Systems: Duet leakage< 6,: perceh[,'RC;`CCA-5. 350.. CFM/ton'.'FWD `TMAH SIMS, and either`HSPP`oP'PSPP. For Packaged Units: Duct leakage!< 6 percent ❑ 3. New Ducts with/or without Required Forms: Replacement . Includes replacing or installing all new ducting and/or outdoor condensing unit CF-611 forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS and/or indoor coil and/or furnace. No or some CF-411 forms: MECH-20 and (for split systems) MECH-25 equipment changed. For Split Systems: Duct leakage < 6 percent; RC, CCA >_ 300 CFM/ton, TMAH For Packaged Units: Duct leakage < 6 percent ❑ 4. New Ducting over 40 feet Required Forms: . Includes adding or replacing more than 40 CF-6111 forms: MECH-04, MECH-2I-HERS linear feet of duct in unconditioned space. CF-4R forms: MECH-21 For split system or packaged units: Duct leakage < 15 percent ❑ EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos. Contractor (Documentation Author's /Responsible Designer's Declaration Statement) . I certify that this Certificate of Compliance documentation is accurate and complete. . I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on :his 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 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: David Beale Signature: David Beale Company: ALL SEASONS AIR CONDITIONING PLUMBING & HEATING INC Date: Nov 7, 201.1 Address: P O BOX 1112 License: 827420 City/State/Zip: PALM DESERT / CA / 92261 Phone: (760) 568-2663 Reg: 211-A0057753A-00000000-0000 Registration Date/Time: 2011/11/07 15:21:08 HERS Provider: Ca--CERTS, Inc. 2008 Residential Compliance Forms July 2010 Bin # Qy of La Quinia Building &r Safety Division P.O. Box 1504, 78-495 Calle Tampico Quinta, CA 92253 - (760) 777-7012 Building�Permit Application and Tracking Sheet Permit # 0La Project Address: Owner's Name: A. P. Number: Address: 4s W n Paseo To-F�t 20 Legal Description: ' Contractor.Al I City, ST, Zip: La0,�(�"� �iC/ +��':�^::^r:iiiiiij�i: is �i::n!•f':<i::i::iiii�liij Telephone: 77�Ls d :.•.:•. }:.•.::<:>•:• : Address: I I Project Description: City, ST, Zip: ,� L /1 ,� �7� F I 1 I' 1 �� f CA q l —b l a- c' ("'V (a . � 1j Tele hone: State Lic. # : City Lic. #: Arch., Engr., Designer: Address: City., ST, Zip: Telephone: : hi...�...{� %i'�}::':��::i:$:+:i::'.:iris"�'y�t�::::::yS:%::: k}:•>-:<<�:« }:•::•>:.:••:•..• Construction Type: Occupacy: State Lic. #: Project type (circle one): New Add'n Aster Repair Demo Name of Contact Person: Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: Estimated Value of Project: d0 . APPLICANT: DO NOT WRITE BELOW THIS LINE q Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cales. Reviewed, ready for corrections Plan Check Deposit Truss Cales. Called Contact Person Plan Check Balance Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2" Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- 3rdReview, ready for corrections/issue Developer Impar. Fee Planning Approval Called Contact Person A.I.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: Enforcement Agency:Permit Number: -711-1220 Y 48617 Paseo Tarazo,.La Quinta CA 92253 (System 1) City of La Quinta This installation certificate is required for compliance for, alterations and additions in existing dwrdlings to space conditioning systems and duct systems. 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 F j ❑ 3. Reduce leakage by 60% and conduct smoke and fix all leaks r ❑ 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 nominal5rF,an{ Flow using one of the,following three calculation methods. ✓ ❑ Cooling method: Size of condenser in Tons (x 400 - CFMjt 7VCM /y�syyyr�stem ✓ ❑ Heatingsystem method: 21 7 xlOutput Capad yAn Thousands of BtXu/hr= Y pl ✓ ❑Measured system airflow using RA3 3_airflow,test procedures: CFM Option'1>used then:, ,,a� ,,.« i " -rL Flow��x 0 5-=l'WC1FM '� '•'� ` • ' "' ' �` ' iv W 1 Allowed leakage -Fan .- ' Actual Leakage = _ CFM • r -Pass if Leakage Actual is less than Allowed Pass Fail. ` Option 2 used then: , Allowed leakage = Fan,Flovu � ..� x 0.10 = _ CFM 2 Actual Leakage to outside,= = CFM w ✓ Pass if Leakage Actual is less than Allowed 0 (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: All accessible leaks repaired using smoke. HERS rater must verify (No sampling). No smoke 4' allowed to leak from system. Including ducts, plenums, air handler and door panel. Pass if all accessible leaks have been repaired using smoke Pass ' Fail y. r. n. y 10 • r Reg: 211-A0057753A-M2100001A-M21A Registration Date/Time: 2012/02/03 15:30:29. HERS Provider: CalCERTS,'Inc. March 2010 2008 Residential Compliance Forms t r l • u _ Fes. 1 '� •All - 7. • y ' �. • ' { ' ` •� �'°�i ^ � , Y : � . . a _ • .•` ' . . fin. S' 4 r •f . . ♦ F A. .� ❑'Outside air. (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall' not be sealed;itaped off " during•duct leakage testing. CFI OA ducts that utilize controlled. motorized dampers; that open,orly when OA ventilation is required to meet ASHRAE Standard 62.2, and close when OA ventilation is not regWred, may ' be configured to the closed position during duct leakage testing. ��.❑All supplyfand#re urri register boots must�be sealed toAhe drywallxif*s,mokextest�isxutilizedTfor$Compliance N u applies�to duct leakage compliance�o``ption 3 .1,leakage; reduction by. —,0%,Y'� ndroptjon'i4 `(f'- all accessible ^°• leaks) d� s�'bed abovek��^❑ New duct`installatlons canno.blize;building cavities ashplenums°or platform returns in lieu,ofducts ., (�}• ❑ Mastic andidraw ltiands,must'be,usediin�mbination7withicloth backed rubber adhesivez.duct tapelto sea ' leaks at all`new duct connections r� 43 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. � t . I am the certified HERS raterrwho performed the verification services identified and reported on this certificate (responsible rater). » • a ' . The installed feature, material, component, or manufactured device requiring HERS verification that is'identified on this certificate (the r r installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified, on the Certificate(s) of Compliance (CF=111) approved by the local enforcement agency. . The information reported on applicable sections of the Installation Certificate(s) (CF -6R), signed and submitted by the pe.son(s) r ; responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -11R) approved by the '� • f t enforcement agency. + Builder or Installer information as shown on the Installation Certificate (CF -611) `. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) , ALL SEASONS AIR CONDITIONING PLUMBING & HEATING INC , Responsible Person's Name: ICSLB r License: , David Beale 827420 r HERS Provider Data Registry Information Sample Group # (if applicable): 259375 ❑ tested/verified dwelling Onot-tested/verified dwelling in la . I , , HERS sample group r HERS Rater Information Ca10ERTS Certificate # CC1-1798605713 , HERS Rater Company Name:. b ~- Air Experts Air Conditioning { Responsible Rater's Name: - Responsible Rater's Signature:. Paul Van Vlymen , . r Paul Van Vlyinen Responsible Rater's Certification Number w/ this HERS Provider: - Date Signed: 10/17/2011 CC2004367. �, r • C Reg: 211-A0057753A-M2100001A-M21A Registration'Date/Time: 2012/02/03 15:30:29 HERS Provider: Ca10ERTS, Inc. ° 2008 Residential Compliance Forms i - March 2010' t• 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 comFliance with the refrigerant charge verification requirement. TMAH and STMS are not required for compliance, when a CIG 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 ar 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 1 1 1:1 Yes ❑ No 5/16 inch (8 mm) access hole upstream of evaporative coil in the returr. plenum and labeled according to Figure in Section RA3.2.2.2.2. 2 ❑Yes [I No 5/16 inch (8 mm) access hole downstream of evaporative coil in the sup -ply 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 , Name'or Ideritification/Tag System The sensor is factory installed, or field installed according to manufacturer's t` OX10 ~ The sensor is factory installed, orFfield installed according to manufacturer's specifications, or islmstalled by methods/specifications'approved bythe Executive_(dy'es specifications, or is installed by methods/specifications approved by the Executive f Director. 4 ❑Yes ..� ❑,No The sensor wire is terminated with a standard mini plug suitable for.cormection,to a'; digitalthermometer The sensocmini plug accessible to the?installing technicians The sensor wire is terminated with a standard mini plug suitable for connection to a 7 ❑ Yes and the HERS rater:without changing the airflow through the condensercoil digital thermometer. The sensor mini plug is accessible to the installing technician When attached to a digital thermometer, the sensor provides an indication of the 5 ❑ Yes, - [3 No 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 ,❑ V ® N/A • ✓ ❑ Pass CTM- - -Pneor 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 When attached to a digital thermometer, the sensor provides an indicaton of the 8 ❑ Yes ❑ No saturation temperature of the coil. Yes to 6, 7, and 8 is a pass. Enter N/A if STMS are not V ® N/A • ✓ ❑ Pass ✓ ❑ Fail applicable. Otherwise enter Pass or Fail - 2008 Residential Compliance Forms `� marcn aulu r L Standard Charge Measurement Procedure (for use if outdoor air dry-bulb is above SS°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 additioral 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 procecure. • 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 . y. System Name or Identification/Tag u .(must be re -calibrated monthly) Date of TherJmocouples Calibration i System Location or Area Served G . Outdoor Unit Serial # h, v Outdoor Unit Make Outdoor Unit Model Nominal Cooling Capacity Btu/hr Date of Verification ' + Measured Lr nunn—r— ,nerrumanre - - Date of Refrigerant Gauge Calibration _ '.� u .(must be re -calibrated monthly) Date of TherJmocouples Calibration (must be re -calibrated monthly) G temperature (Tsupply, db) • { h, v Date of Refrigerant Gauge Calibration _ '.� u .(must be re -calibrated monthly) Date of TherJmocouples Calibration (must be re -calibrated monthly) IL ir?, •fir ij }r System Name or Identification/Tag u f. .�. Supply (evaporato'r leaving)'air dry-bulb' temperature (Tsupply, db) • { Return (evaporator entering) air dry-bulb temperature (Treturn, db) 3' Return (evaporator entering) air wet -bulb temperature (Treturn, wb)' Evaporator saturation temperature (Tevaporator, sat) y Condensor. saturation temperature r (Tcondensor, sat) 4 Suction line temperature (Tsuction) + Liquid Line Temperature (Tliquid) ' �e Condenser (entering) air dry-bulb temperature (Tcondenser, db) r ,Reg: 211-A0057753A-M2500001A-M25A Registration Date/Time:.2012/02/03 15:32:56 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms r March 2010 INSTALLATION CERTIFICATE CF-411-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (P3ge 3 of 5) Site Address: Enforcement Agency: Permit Number: 48617 Paseo Tarazo, La Quinta CA 92253 City of La Quinta 11-1220 Temperature Split Method Calculations for determining Minimum Airflow Requirement for Refrigerant Charge Verification. The temperature split method is specified in Reference Residential Appendix RA3.2. System Name or Identification/Tag Calculate: Actual Temperature Split = Treturn, db - Tsupply, db Target Temperature Split from Table RA3.2-3 using Treturn, wb and Treturn, db Calculate difference: Actual Temperature Split - Target Temperature Split = Passes if difference is between -4°F and +4°F or, upon remeasurement, if between -4°F and -100°F Enter Pass or Fail Note: Temperature Split Method Calculation is not necessary if actual Cooling Coil Airflow is verified using one of the airflow measurement procedures specified in Reference Residential Appendix RA3.3. If actual cooling coil airflow is measured, the value must be equal to or greater than the Calculated Minimum Airflow Requirement in the table below. Calculated Minimum Airflow Requirement (CFM) = Nominal Cooling Capacity (ton) X 300 (cfm/ton) System Name- r iaentification/Tag Calculate Minimum Airflow -Requirement (CFM) ! Measured Airflow using RA3.3,procedures Passes if measured airflow is g'reater:thamolr equal to the calculated minimum airflow requirement. Enter Pass or Fail Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for fixed orifice metering device systems 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 r P Reg: 211-A0057753A-M2500001A-M25A Registration Date/Time: 2012/02/03 15:32:56 HERS Provi3er: CalCERTS, Inc. 2008.Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Rage 4 of 5) Site Address: Enforcement Agency: Permit Number: 48617 Paseo Tarazo, La Quinta CA 92253 1 City of La Quinta 11-1220 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 Enter allowable superheat range from Target Subcooling specified by manufacturer Calculate difference: Actual Subcooling - Target Subcooling = System passes if difference is between �� f• _ -4°F and +4°F r• 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 Calculate: Actual Superheat = Tsuction - Tevaporator, sat Enter allowable superheat range from manufacturer's specifications (or use range between 3°F and 26°F if manufacturer's specification is not available) System passes4 actual superheat is;— it iin,the allowable superheat range �Ijj ,� �� f• _ Enter•Pass or Fail r• Reg: 211-A0057753A-M2500001A-M25A Registration Date/Time: 2012/02/03 15:32:56 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5) Site Address: Enforcement Agency: Permit Number: 48617 Paseo Tarazo, La Quinta CA 92253 City of La Quint a 11-1220 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. Responsible Person's Name: 1827420 CSLB License: David Beale HERS Provider Data Registry Information System Name or Identification/Tag ❑tested/verified dwelling Onot-tested/verified dwelling in Sample (if applicable): System meets all refrigerant charge and airflow HERS Rater Information CaICERTS Certificate # CC1-1798605713 HERS Rater Company Name: Air Experts Air Conditioning Responsible Rater's Name: requirements. Enter Pass or Fail Paul Van Vlymen Paul Van Vlymen Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 10/17/2011 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 (responsi:)le rater). The installed feature, material, component, or manufactured device requiring HERS verification that is identified on this certificate (the installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified on the Certificate(s) of Compliance (CF -1R) approved by the local enforcement agency. The information reported on applicable sections of the Installation Certificate(s) (CF -6R), signed and submitted by the person(s) responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -1R) approved by the L Builder or Installer information as shown on the Installation Certificate (CF -6R) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) ALL SEASONS AIR CONDITIONING PLUMBING & HEATING INC Responsible Person's Name: 1827420 CSLB License: David Beale HERS Provider Data Registry Information Group # 259375 ❑tested/verified dwelling Onot-tested/verified dwelling in Sample (if applicable): a HERS sample groin HERS Rater Information CaICERTS Certificate # CC1-1798605713 HERS Rater Company Name: Air Experts Air Conditioning Responsible Rater's Name: Responsible Rater's Signature: Paul Van Vlymen Paul Van Vlymen Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 10/17/2011 CC2004367 Reg: 211-A0057753A-M2500001A-M25A Registration Date/Time: 2012/02/03 15:32:56 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 Space Conditioning Systems Heating Equipment Equip Type (package- heat pump) 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 Loac (kBtu/hr)" Heating Capacity (kBtu/hr) Split Furnace Carrier PG83AA08090AE5A 1 1 80 AFUE 4 Tons t.00itnq equlpmenr Equip Type (package heat pump) CEC Certified Mfr. Name and Model Number ARI Reference Number2 # of Identical Systems Efficiency (SEER and EER) 1, 3 (>=CF -1R value)4 Duct Location (attic, crawl- space, Duct etc.) R -value Cooling Load (kBtu/hr) Cooling Capacity (kBtu/hr) Split A/C Carrier PA13NA048-C 1 13 SEER 4 Tons 1. lrpruiecc is new consrrucrlon, see l-ootnotes to Jtancaras laDle 1S1-tS ana ladle 15i -c ror Duct ceuurg.alternative compliance. 2. ARI Reference Number can be found by entering the equipment model number at http://www.al-idirectory. org/ari/ac. php 3. Listed efficiency on this page must be greater than or equal ( ? ) to the value shown on the CF -IR form. 4. When CF -1R 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 v §110-§113: HVAC equipment is certified by the California Energy Commission. v §150(h): Heating and/or cooling loads calculated in accordance with ASHRAE, SMACNA, or RCCA. §150(1): Setback Thermostat on all applicable heating and/or cooling systems meet the requirements of §112(6). V §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. Reg: 7.11-A0057753A-N0400001A-0000 Registration Date/Time: 207.2/01/19 12:48:06 REPS Pro-ider: Ca]CEP.TS, Inc. 2006 residential Compliance Forms ':uguSi- 2009 INSTALLATION CERTIFICATE Space Conditioning Systems, Ducts and Fans CF -6R -MEC Site Address: Enforcement Agency: Permit Nur 48617 Paseo Tarazo, La Quinta CA 92253 (System 1) City of La Quinta 11-1220 - Ducts and Fans of 2) §150(m): Duct and Fans 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 181B or aerosol sealant that meets the requirements of UL 723. If mastic or tape is used to seal openings greater than 1/4 inch, tl-e combination of mastic and either mesh or tape shall be used; and V 1. Building cavities, support platforms for air handlers, and plenums defined or constructed with 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 installer in cavities and support platforms shall not be compressed to cause reductions in the cross-sectional area of the ducts. v 2D. Joints and seams of duct systems and their components shall not be sealed with cicth 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. * 8. Gravity ventilating systems serving conditioned space have either automatic or readiiy accessible, manually operated dampers. V 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. V 10. Flexible ducts cannot have porous inner cores. DECLARATION STATEMENT . I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. . I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized representative of the person responsible for construction (responsible person). . I certify that the installed features, materials, components, or manufactured devices identified on this certificate (the installation) conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the enforcement agency. . I 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. e I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made availablike 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. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) ALL SEASONS AIR CONDITIONING PLUMBING & HEATING INC Responsible Person's Name: Responsible Person's Signature: David Beale David Beale CSLB License: 827420 Date Signed: 11/9/2011 position With Company (Title): Reg: 217.-A0057753A-M0400001A-0000 Registration: Date/Time: 2012/01/19 1.2:46:03 HERS Provider: Ca10ERTS, frac. 2003 Resider_tiai Compliance Forms August 2009 v Enter the Duct System Name or Identification/Tag: Zone 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. This installation certificate is required for compliance for alterations and additions in existing swellings to space conditioning systems and duct systems. Note: For existing dwellings, a completely new or replacement duct system can also include e;.risting 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. Fora completely new or replacement duct system installed in an existing dwelling, use the Installation Certificate titled "Duct Leakage Test - Completely New or Replacement Dust System. " Duct Leakage Diagnostic Test - existino duct system Select one compliance method from the following four choices. 1. Measured leakage less than 15% of fan flow 2. Measured leakage to outside less than 10% of Fan Flow 3. Reduce leakage by 60% and conduct smoke and fix all leaks 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 nominal Fan Flow using one of the following three calculation methods. Cooling system method: Size of condenser in Tons _ 4 x 400 = 1600 CFM Heating system method: 21.7 x _ Output Capacity in Thousands of Btu/hr = _ CFM / Measured system airflow using RA3.3 airflow test procedures: _ CFM Option 1 used then: 1 Allowed leakage = Fan Airflow 1600 x 0.15 = 240 CFM Actual Leakage = 230 CFM Pass if Actual Leakage is less than Allowed leakage Pass Fail Option 2 used then: 2 Allowed leakage = Fan 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 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: 217.-A0051753A-h12100001A-0000 Registration Date/Time: 2012/01/19 12:48:43 HERS Provider.: Ca10ERTS, Inc_.~ 2009 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE Duct Leakage Test - Existing Duct System Site Address: I Enforcement Agency: 48617 Paseo Tarazo, La Quinta CA 92253 (System 1) 1 City of La Quinta CF-6111-MECH-21-H ( Page 2 Permit Number: 11-1220 V Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sea ed/taped off during duct leakage testing. CFI OA ducts that utilize controlled motorized dampers, that opera only when OA ventilation is required to rneet ASHRAE Standard 62.2, and close when OA ventilation is not required, may be configured to the closed position during duct leakage testing. All supply and return register boots must be sealed to the drywall if smoke testis utilized for compliance - applies to duct leakage compliance option 3 (leakage reduction by 60%) and option 4 (fix all] accessible leaks) described above. v New duct installations cannot utilize building cavities as plenums or platform returns in lieu cof ducts. v Mastic and draw bands must be used in combination with cloth backed rubber adhesive duct* tape to seal leaks at all new duct connections DECLARATION STATEMENT . 1 certify under'penalty of perjury, under the laws of the State of California, the information provided on this form is tru=- 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). o I certify that the installed features, materials, components, or manufactured devices identified on this certificate (the irstallation) conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications app•-oved by the enforcement agency. e I understand that a HERS rater will check the installation to verify compliance, and that that if such checking identifies defects, I am required to take corrective action at my expense. I understand that Energy Commission and HERS provider representatives will also perform quality assurance checking of installations, including those approved as part of a sample group but not checke•J 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. o 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 iinspections. 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 buildinnc Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) ALL SEASONS AIR CONDITIONING PLUMBING & HEATING INC Responsible Person's Name: Responsible Person's Signature: David Beale David Beale CSLB License: 827420 Date Signed: 11/9/2011 position With Company (Title): Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? Yes No �.�y: cii-::wa'i7��.-1°I1I000U.LH-0000 Registration Date/`lime: 2012;"01/7.9 12:48:48 HERS Provider.: Ca10ERTS, 7:nc. 2008 Pesidential Compliance Forms March 2010 INSTALLATION CERTIFICATE* CF-611-M°CH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure .(Page 1 of 5) Site Address: f Enforcement Agency: Permit Number: 48617 Paseo Tarazo, La Quinta CA 92253 City of La Quinta 11-1220 Note: If installation of a Charge Indicator Display (CID) is utilized as an alternative to refrigerant charge v=rification for compliance, a MECH-24 Certificate (instead of this MECH-25 Certificate) should be used to demonstrate ccmpliance 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 Measuirement Sensors (SIMS) Procedures for installing TMAH are specified in Reference Residential Appendix RA3.2. If refrigerant charge verification is required for compliance, TMAH are also required for compliance. SIMS are only required for completely new or replacement space -conditioning systems that utilize prescriptive compliance method. TMAH - Access Holes in Supply and Return Plenums of Air Handler System Name or Identification/Tag Zone 1 System Location or Area Served Whole House 1 v 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 Fail ✓ ✓ Pass ✓ Fail SIMS - Sensor on the Evaporator Coil System Name or Identification/Tag Zone 1 The sensor is factory installed, or field installed according to manufac_urer's 3 Yes No specifications, or is installed by methods/specifications approved by tie Executive Director. The sensor wire is terminated with a standard mini plug suitable for onnection to a 4 Yes No digital thermometer. The sensor mini plug is accessible to the installirg 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.= degrees F EalYes , and 5 is a pass. Enter N/A if STMS are not✓ ✓ N/A ✓ Pass ✓ Fail Otherwise enter Pass or Fail STMS - Sensor on the Condenser Coil System Name or Identification/Tag Zone 1 The sensor is factory installed, or field installed according to manufac-_urer'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 installirg 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.= 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 Rag: 21.1-A0057753.A-M2500001A-0000 Registration Date/Time: 2012/01/1.9 12:50:27 HERS Provider: Ca10EP,T.S 1;11c 2008 Residem:.ial compliance Forms Aujjusi 2009 INSTALLATION CERTIFICATE Refrigerant Charge Verification - Standard Measurement Procedure Site Address: Enforcement Agency 48617 Paseo Tarazo, La Quinta CA 92253 City of La Quinta CF-6R-M.ECH-25-H ERS (Page 2 of 5) Permit Nu-nber: 11-1220 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 adeitional 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 pncedure. • 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 Zone 1 (must be re -calibrated monthly) Date of Thermocouple Calibration 11/1/11 System Location or Area Served Whole House Outdoor Unit Serial # 0410X64139 Outdoor Unit Make Payne Outdoor Unit Model PA13NA048-C Nominal Cooling Capacity Btu/hr 48000 Date of Verification 11/9/11 --•�••••�• • �..anvou� 611Ol. MIIICIII� Date of Refrigerant Gauge Calibration it/1/il (must be re -calibrated monthly) Date of Thermocouple Calibration 11/1/11 (must be re -calibrated monthly) System Name or Identification/Tag Zone 1 Supply (evaporator leaving) air dry-bulb 54 temperature (Tsupply, db) Return (evaporator entering) air dry-bulb 74 temperature (Tretorn, db) Return (evaporator entering) air wet -bulb 56 temperature (i return, wb) Evaporator saturation temperature 30 (Tevaporator, sat) Condensor saturation temperature 80 (Tcondensor, sat) Suction line temperature (Tsuction) 51 Liquid Line Temperature (Tliquid) 70 Condenser (entering) air dry-bulb 78 temperature (Tcondenser, db) 0 Reg: 217.-A0057753A-M2500001A-0000 Regis ration Data/Time: 207.2/01/3.9 12:S0:2? HERS Provider.: Ca]CERTS, Inc. 2008 Residential Compliance Forms Auguec 2009 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 Zone 1 Calculate: Actual Temperature Split = Treturn, db 20.00 - Tsup2ly, db Tsuction - Tevaporator, sat Target Temperature Split from Table RA3.2-3 21 Target Superheat from Table RA3.2-2 using using Treturn, wb and Treturn, db Calculate difference: Actual Temperature Split - _1 Target Temperature Split = Calculate difference: Passes if difference is between -3°F and +3°F or, Actual Superheat - Target Superheat = upon remeasurement, if between -3°F and -100°F PASS System passes if difference is between -5°F and 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 of, greater than the Calculated Minimum Airflow Requirement in the table below. Calculated Minimum Airflow Requirement (CFM) = Nominal Cooling Capacity (ton) X 300 (cfm/ton) System Name or Identification/Tag Zone 1 Calculated Minimum Airflow Requirement (CFM) Measured Airflow using RA3.3 procedures (CFM) Passes if measured airflow is greater than or equal to the calculated minimum airflow requirement. Enter Pass or Fail Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is requiied to be used for fixed orifice metering device systems System Name or Identification/Tag Zone 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 Rag: 211-A0057753A-M2500001A-0000 2008 residential Compliance Forms Registration Date/Time: 2012/01/19 12:50:27 HERS Prodder: Ca10ERTS, Inc. August 2009 Subcooling Charge Method Calculations for Refrigerant Charge Verification. This procedure is regjired to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag Zone 1 Calculate: Actual Subcooling = Tcondenser, sat - Tliquid 10.0 Target Subcooling specified by manufacturer 10 Calculate difference: 0 Actual Subcooling - Target Subcooling = System passes if difference is between -3°F and t3°F PASS Enter Pass or Fail PASS Metering Device Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag Zone 1 Calculate: Actual Superheat = Tsuction - Tevaporator, sat 21.0 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 actual superheat is within the allowable superheat range PASS Enter Pass or Fail E Reg: 211-A0057753A-M2500001A-0000 Registration Date/Time: 201.2/01/19 1.2:50:27 iiERS Prov2der.: Ca10ERTS, Inc. 2008 residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH- Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5) Site Address: Enforcement Agency: Permit Number: 48617 Paseo Tarazo, La Quinta CA 92253 City of La Quinta 11-1220 Standard Charge Measurement Summary: System shall pass both refrigerant charge criteria, metering device criteria (if applicable), and minimum ooling 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 Zone 1 CSLB License: 827420 Date Signed: 11/9/2011 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 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 eiiaible 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). o 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. o 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 representat'ves will also perform quality assurance checking of installations, including those approved as part of a sample group but not checked by a HERS rater, and if those installations fail to meet the requirements of such quality assurance checking, the required corrective action and additional checking/testing of other installations in that HERS sample group will be performed at my expense. e I reviewed a copy of the Certificate of Compliance (CF -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 hi,ildinnc Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) ALL SEASONS AIR CONDITIONING PLUMBING & HEATING INC Responsible Person's Name: Responsible Person's Signature: David Beale David Beale CSLB License: 827420 Date Signed: 11/9/2011 Position With Company (Title): Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? Yes No Redd 2:1.1-A0057753A-M2500001A-0000 Registration Date/.Time: 2012/01/19 12:50:27 ^HERS Provider CaICER.TS, Inc. 2006 Residential Compliance Forms 2009