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12-0682 (MECH)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 12-00000682 Property Address: 78960 CARMEL CIR APN: 646-400-007- - Application description: MECHANICAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 8000 T4ht 4 4 Q" Applicant: Architect or Engineer: ------------------ LICENSED CONTRACTOR'S DECLARATION BUILDING & SAFETY DEPARTMENT BUILDING PERMIT I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License ss: C20 C36 UaeoteNo 906115 �te: � � tractor. 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 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). 1 _ I 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). 1— I I am exempt under Sec. , B.&P.C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.)• Lender's Name: Lender's Address: LQPERMIT Owner: ARGENTINE PETER D 78960 CARMEL CIRCLE LA QUINTA, CA 92253 Contractor: HYDES 42949 MADIO STREET INDIO, CA 92201 (760)360-2202 Lic. No.: 906115 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 6/19/12 1 � A ------------------------------------------------ WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier NORGUARD INS Policy Number CEWC243358 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 f rthw' f compl�7vith those provisions. /uatev � �lipplicant: _ _ 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, indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives ofthiscounty to enter upon the above-mentioned property or in ction ses. Da eY Signature (Applicant or Agentl- 0 LQPERMIT Application Number . . . . . 12-00000682 Permit . . . MECHANICAL Additional desc . . Permit Fee . . . . 40.50 Plan Check Fee 10.13 Issue Date Valuation . . . . 0 Expiration Date 12/16/12 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 9.0000 EA MECH FURNACE <=100K 9.00 •1.00 16.5000 EA MECH B/C >3-15HP/>100K-500KBTU 16.50 ---------------------------------------------------------------------------- Special Notes and Comments HVAC CHANGE -OUT: 5 TON 16 SEER, FURNACE, CONDENSER, INDOOR COIL. 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 #: 78-960 Carmel Circle La Quinta, CA 92253 City of La Quinta Jun 19, 2012 Duct insulation Conditioned Floor Equipment Type1 List Minimum Efficiency2 requirement Area Thermostat ❑ Package Unit p Furnace 0 AFUE 78% ❑ COP ❑ R 6 (CZ 10-13) Served by system (a Setback p Indoor Coil a SEER 13.0 ❑ HSPF ❑ R 8 (CZ 14-15) 2000 sf If not already present, must be p Condensing Unit [I 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 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 -611 and registered CF -4R forms (no hand filled CF-4Rs allowed) are filled out and signed.Beginning October 1, 2010, a registered copy of the CF -1111 and CF -6R shall also be on site for final inspection. © 1. HVAC Changeout Required Forms: . All HVAC Equipment CF -6R 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 . Indoor Coil and /or CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS . Furnace CF -4R forms: MECH-21 and (for split systems) MECH-25 For Split Systems: Duct leakage�< 15 percent; RC, CCA <_ 300 CFM/ton (Minimum Air Flow Requirement), TMAH leakage i; FGF Parikaged WIRits, -P-wt 15 peFeeRt 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. The system will not be Ducted (ie DuctlessroMini-Split System).(Also" Exempt fromrRefrigerant Charge) ❑ 2. New HVAC Syitem Required Forms: ' re . Cut infor Changeout with",'` new ducts": (all 'e CF -6R forms: MECH-04, MECH=20-HERS, and (for split systems) MECH-22=HERS, and new ducting and all new � 'MECH=25-HERS � �'• CF 4R'forms: MECH-20, and (for split and MECH-25 equi ment system's).MECH-22, For Split Systems: Duct lea kage < 6'percent;'RC, CCA >_ 350 CFM/ton, FWD,.TMAH, STMS, and either HSPP or'PSPP For Packaged Units: Duct leakage < 6 percent 113. ' New Ducts with/or without Required Forms: Replcement If . Includes replacing or installing all new ducting and/or outdoor condensing unit CF -6R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS and/or indoor coil and/or furnace..No or some CF -4R 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 114. New Ducting over 40 feet Required Forms: . Includes adding or replacing more than 40 CF -6R 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 this Certificate of Compliance. • I certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24, Parts 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: Mark Hyde Signature: Mark Hyde Company: CERTIFIED COMFORT SYSTEMS INC Date: Jun 19, 2012 Address: 42-949 MADIO STREET License: 906115 City/State/Zip: INDIO / CA / 92201 Phone: (760) 360-2202 Reg: 212-A0031742A-00000000-0000 Registration Date/Time: 2012/06/19 12:51:37 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms July 2010 Work Order IIIIIIIIIIIIIIIIII ' Certified Comfort Systems, Inc. Job No: 240894 dba Hyde's Air Conditioning +; 42-949 Madio St. Indio CA 92201 760-360-2202 FAX: 760-360-3350 Service At: Customer # 102897 Bill To: Customer # 102897 Rating: Argentine, Peter cell Type Sys Mfg Model # Type: RES Source: EXIST Age Type Open Balance: COIL 1 AS 4XUC1348/100 Zone: LQ Map: 1 5YR-P&L Payment Method: COD Filters: Loc: Subdivision: Credit Limit: Size: Skill: Tax: CA Installation Customer COND 1 AS Directions Rancho La QUinta 11142S4X5F 1 Instructions instlling 5 Ton 16 SEER Am Stnd. cust paid in full 05/26/2031 Work Sugg Loc: Work Done Removed existing equipment and installed a new 5 ton 16 Seer American Standard heating and cooling system. ARI#4586004 Size: 4 TON ***5 YEAR LABOR AND 10 YEAR PARTS AND 20 YEAR HEAT EXCHANGER WARRANTY*** Call Info Job Info COND 2 AS Call No.: 240894 Booked by: Gina Job No.: 240894 Taken: 6/12/12 1:25 PM Type: FULL Booked Date: 6/15/12 Class: Installation Taken by: Gina Scheduled: 6/15/12 8:OOAM Sched by: Gina Type: FULL Cust PO: Pri Level: 5 Ld Src: EXIST SalesPerson: Eq Age: LS Ref: Contact: Equipment: A/C Assignments Employee TaskCode Scheduled Time ADRIAN 9:30:00 AM LUISM 9:30:00 AM Equipment Warranties Type Sys Mfg Model # Serial # Age Type Parts Ends Labor Ends COIL 1 AS 4XUC1348/100 QNV290357 1 5YR-P&L 05/26/2016 05/26/2016 Filters: Loc: Size: COND 1 AS 4A7133048131000AA 11142S4X5F 1 20YR HEXCH 05/26/2031 Filters: Loc: Size: 4 TON COND 2 AS 4A7A5061E1000BA 1219161,32F 0 IOYR COMP 06/18/2022 Filters: Loc: Size: 5 ton COIL 1 AS 4XUC1365/100 SMC130598 0 5YR-P&L 06/18/2017 06/18/2017 Filters: Loc: Size: 5 TON FURNAC 1 AS AUD2C100B9V5VBA 1219284LIG 0 20YR HEXCH 06/18/2032 Filters: Loc: Size: 5 TON Agreements Type Agr No Status Sold By Start End Discount Last Visit Next Scheduled Bin # Cityof La Quinta Building 0 Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit.# ' P, Project Address:' Owner's Name: `e Qn A. P. Number: Address: legal Description: City, ST, Zip: G �Z contractor:e 5 (c- Telephone: Address: Project Description: .pity, ST, Zip: L1,00 i (2) G A q-2:10 Telephone: _��(/ State Lie. # City Lie. #: b Arch., Engr., Designer: Address: City, ST, Zip: Telephone: Construction Type: Occupancy: State Lie. #: Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: Estimated Value of Project- Opp APPLICANT: DO NOT WRITE BELOW THIS UNE # Submittal Req'd Recd TRACKING. PERMIT FEES Plan Sets Plan Check submitted item Amount Structural Cates. Reviewed, ready for corrections Plan Check Deposit Truss Cates. Called Contact Person Plan Check Balance Energy Cates. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading. plan 21' Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M L H.O.A. Approval Plans resubmitted Grading IN HOUSE: '"' Review, ready for eorrectionslissue Developer -Impact Fee Planning Approval Called Contact Person A.LP.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees »1L INSTALLATION CERTIFICATE CF-6R-MECH-04 Space Conditioning Systems, Ducts and Fans (Page 1 of 2) Site Address: 78-960 Carmel Circle, La Quinta CA 92253 (System Enforcement Agency: Permit Number: 1) City of La Quinta 12-682 Space Conditioning Systems Heating Equipment E:giip , hype (paekag2•: 'heat_ .omp) CEC Certified Mfr. Name and Model Number ARI Reference Number2 # of Identical Systems Efficiency (AFUE, etc.)1, 3 (>=CF -SR value)4 Duct Location (attic, crawl- space, etc.) Duct R -value Heating Load (kBtu/hr) Heating Capacity (kBtu/hr) ,.Split Mce american standard aud2c100b9v5vba 1 80 AFUE Attic R-4.2 80 100 kl3tu Type 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) and Model Number { Number2 Systems value)4 etc.) R -value (kBtu/hr) (kBtu/hr) Split me5061 standard 4+' ` "" �. 16 SEER c YR Vit Cooling Equipment 1. If project is new construction, see Footnotes to Standards Table 151-B and Table 151-C for duct ceiling alternative compliance. 1 2. ARI Reference Number can be found by entering the equipment model number at http://www.aridirectory. org/ari/ac. php # 3. Listed efficiency on this page must be greater than or equal ( ? ) to the value shown on the CF -1R form. 4. When CF -IR is reference it is also applicable to the CF -1R, 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. 0 §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). © §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. 6_! Reg: 212-A0031742A-M0400001A-0000 Registration Date/Time: 2012/06/22 17:59:10 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 Efficiency Duct Equip (SEER Location Type 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) and Model Number { Number2 Systems value)4 etc.) R -value (kBtu/hr) (kBtu/hr) Split me5061 standard 4+' ` "" �. 16 SEER c YR Vit A/C A/C �" 4aia5061e1000ba X4586004 :� 1 . 13 EER Attic -4.2V/ R-�`4.2 ��jj 55 kBtu f � 0 /1 �r � t j 1. If project is new construction, see Footnotes to Standards Table 151-B and Table 151-C for duct ceiling alternative compliance. 1 2. ARI Reference Number can be found by entering the equipment model number at http://www.aridirectory. org/ari/ac. php # 3. Listed efficiency on this page must be greater than or equal ( ? ) to the value shown on the CF -1R form. 4. When CF -IR is reference it is also applicable to the CF -1R, 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. 0 §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). © §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. 6_! Reg: 212-A0031742A-M0400001A-0000 Registration Date/Time: 2012/06/22 17:59:10 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-04 Space Conditioning Systems, Ducts and Fans (Page 2 of 2) Site Address: 78-960 Carmel Circle, La Quinta CA 92253 (System Enforcement Agency: Permit Number: 1) City of La Quinta 12-682 Ducts and Fans §150(m): Duct and Fans 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 tl,ict's 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, 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 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 installed in cavities and support platforms shall not be compressed to cause reductions in the cross-sectional area of the ducts. ❑ 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. ❑ 8. 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! ❑ 10. Flexible ducts cannot have, porous,inner cores. 4,11 0 DECLARATION STATEMENT 1 . 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. . 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. . Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) CERTIFIED COMFORT SYSTEMS INC Responsible Person's Name: Responsible Person's Signature: Mark Hyde Mark Hyde CSLB License: Date Signed: Position With Company (Title): 906115 6/15/2012 Reg: 212-A0031742A-M0400001A-0000 Registration Date/Time: 2012/06/22 17:59:10 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: 78-960 Carmel Circle, La Quinta CA 92253 (System Enforcement Agency: Permit Number: 1) City of La Quinta 12-682 Enter the Duct System Name or Identification/Tag: System 1 rhter tlie:)uct System Location or Area Served: Whole House N046 ,Submit one Installation Certificate for each duct system that must demonstrate compliance in the ia'we�lIng. 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 dud system Select one compliance method from the following four choices. 0 1. Measured leakage less than 15% of fan Flow ❑ 2. Measured leakage to outside less than 10% of Fan Flow 0 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 _Opti on 4.)� Determineominal Fan -Flow using one'oflthefollowing three calculation methods. AY ' '! ✓ 2 Cooling.system mfl'ethod: Size of condenser in Tons 15 x 400 = e 2000 CFM r- 17 >' '. ✓ Heating system method 21.7 + Output Capac ty in Thousands of Btu hr = _CFM - ❑ Mea`sureii system aFirfl using RA3.3 airflow est"procedures: _CFM Option 1 used then: 1 Allowed leakage = Fan Airflow 2000 x 0.15 = 300 CFM Actual Leakage= 269 CFM _- Pass if Actual Leakage is less than Allowed leakage Pass Fail Option 2 used then: f 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% p 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 p Pass p Fail a 0 Reg: 212-A0031742A-M2100001A-0000 Registration Date/Time: 2012/06/22 17:57:33 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS Duct Leakage Test — Existing Duct System (Page 2 of 2) Site Address: 78-960 Carmel Circle, La Quinta CA 92253 (System Enforcement Agency: Permit Number: 1) City of La Quinta 12-.682 0 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. L D All supply and return register=boots-must beNsealed to the drydwall if smoke testis u1 ilized forcompliance — applies+torduct leakage compliance option 3 (leakage reduction,by 60%) and option 4((fix alliaccessible leaks) described above.4 - 0 © New duct:installahions cannot utilize building cavities as lenums2or latfo/m returns in lieu of ducts r�� C, 0 Mastic and draw bands must be used in combination with cloth backed rubberadhesiveduct tape to seal leaks at all new .d.-u-+ct connections DECLARATION STATEMENT 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 -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 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) CERTIFIED COMFORT SYSTEMS INC Responsible Person's Name: Responsible Person's Signature: Mark Hyde Mark Hyde CSLB License: Date Signed: Position With Company (Title): 906115 6/15/2012 Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? ❑ Yes ❑ No Reg: 212-A0031742A-M2100001A-0000 2008 Residential Compliance Forms Registration Date/Time: 2012/06/22 17:57:33 HERS Provider: CalCERTS, Inc. March 2010 INSTALLATION CERTIFICATE* CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 5) Site Address: Enforcement Agency: Permit Number: 78-960 Carmel Circle, La Quinta CA 92253 1 City of La Quint a 12-682 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 th2 refrigerant charge verification requirement. TMAH and STMS are not required for compliance, when a CID is utilized far,cbmpliance. As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional form(s) for ehy 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 i System Location or Area Served Whole House 1 p 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 p 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. l Enter Pass or Fail ✓ 0 Pass ✓ ❑ Fail STMS - Sensor on the Evaporator: Coil _ System Narne:orrIdehtification/TagJ System 1 --!Ir ) „_N N, At, 3 ' ❑ Yes EINo The'sensor is factory installed, or field installed according to manufacturer's specifications, or is�installetl by methods` /specifications approved by the Executive 6 ❑ Yes -. Director. 4 ❑ Yes �►f,/y ; JG El No The sensor wire is'terminated with a,standard mini plug suitable for connection to a' digital'therm'05meter. The:sensor mini plug is accessible to the installing technician' ,� and the HERS'rater without changing the airflow through the condenser coil` 5 ❑ Yes I ❑ No IThe sensor measures the saturation temperature of the coil within 1.3 degrees F Yes to 3, 4, and 5 is alpass. Enter N/A if STMS are not applicable. Otherwise enter Pass or; Fail ,i p N/A ✓ ❑Pass ✓ ❑Fail STMS - Sensor on the Condenser Coil System Name or Identification/Tag I 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 ✓ p N/A ✓ ❑ Pass ✓ ❑ Fail applicable. Otherwise enter Pass or Fail i Q u Reg: 212-A0031742A-M2500001A-0000 Registration Date/Time: 2012/06/22 17:57:03 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5) Site Address: Enforcement Agency: Permit Number: 78-960 Carmel Circle, La Quinta CA 92253 City of La Quinta 12-682 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 difD additional systems in the dwelling as applicable. • The SyAt&h'should be installed and charged in accordance with the manufacturer's specifications before starting this procedure. fie;sysfeiri must meet minimum airflow requirements as prerequisite for a valid refrigerant charge test. • Jf 600bbr air dry-bulb is 55°F or below, the installer must use the Alternate Charge Measurement Procedure, SpaGE 6Aelitioning Systems 3ys'tei'h Name or Identification/Tag System 1 (must be re -calibrated monthly) System Location or Area Served Whole House 6/15/,201 T tF must be re calibrated monthly) f! Outdoor Unit Serial # 1219161132f ;. V t1 =w Outdoor Unit Make american standard Outdoor Unit Model 4a7a5061e1000ba Nominal Cooling Capacity Btu/hr 60000 Date of Verification t 6/15/2012 Calibration of Diagnostic Instruments Date of Refrigerant Gauge Calibration 6/15/2012 (must be re -calibrated monthly) Date of Thermocouple,, Calibration j 6/15/,201 T tF must be re calibrated monthly) f! Supply (evaporator leaving),air dry-bulb= Measured Temperatures(.; F) / ) ] I +,'f 1 - 1 L X ,fj System Name or Identifi ation[T g'- , System 1 Supply (evaporator leaving),air dry-bulb= ;. V t1 =w temperature (Tsupply, db) Return (evaporator entering) air dry-bulb temperature`(Treturn db) 1 Return (evaporator entering) air wet -bulb temperature (Treturn, wb) I Evaporator saturation temperature 45 (Tevaporator, sat) Condensor saturation temperature 112 (Tcondensor, sat) Suction line temperature (Tsuction) 60 Liquid Line Temperature (Tliquid) 102 Condenser (entering) air dry-bulb 104 temperature (Tcondemser, db) WE Reg: 212-A0031742A-M2500001A-0000 Registration Date/Time: 2012/06/22 17:57:03 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: Enforcement Agency: Permit Number: 78-960 Carmel Circle, La Quinta CA 92253 1 City of La Quinta 12-682 Minimum Airflow Reauirement 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. Syt'em Name or Identification/Tag System 1 Calculate: Actual Superheat = C"altulate: Actual Temperature Split = Treturn, Tsupply, db Target Temperature Split from Table RA3.2-3 "Ing Treturn, wb and Treturn, db Calculate difference: Actual Temperature Split - Tirget Temperature Split = Passes if difference is between -3°F and +3°F or, upon remeasurement, if between -3°F and -100°F Enter Pass or Fail 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. i Calculated Minimum Airflow Requirement (CFM) = Nominal Cooling Capacity (ton) X 300 (cfm/ton) L System Na e,or Identification/Tag 7 System 1 lie!,ff Calculated Minimum Airflow Requirement (CFM) 1500 Measured+Airflow using RA3.3 procedures CFM ,C 1825 ~7 Passes if measured airflow is greater than or equal to the calculated minimum airflow requirement.— Enter Pass or Fail PASS 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 Enter Pass or Fail [At Reg: 212-A0031742A-M2500001A-0000 Registration Date/Time: 2012/06/22 17:57:03 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5) Site Address: Enforcement Agency: Permit Number: 78-960 Carmel Circle, La Quinta CA 92253 1 City of La Quinta 12-682 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 Superheat = 15.0 Calculate: Actual Subcooling = 10.0 :: T _gondenser, sat - liquid Target Subcooling specified by manufacturer 8 Calculate difference: 2 Actual Subcooling - Target Subcooling = System passes if difference is between I PASS -3°F and +3°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 I L Enter allowable superheat range from manufacturer's specifications (or use range 4-25 between 4°F and 25°F if manufacturer's specification is not available) j System passes,if actual'superheat is•w,ithin.the allowable superheat range f, I PASS Enter Pass or Fail r-"''"• __.__ _._.. � �� 'ice � �,�� .��L? �y Reg: 212-A0031742A-M2500001A-0000 Registration Date/Time: 2012/06/22 17:57:03 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: 78-960 Carmel Circle, La Quinta CA 92253 City of La Quinta 12-682 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: Date Signed: Position With Company (Title): System meets all refrigerant charge and airflow 6/15/2012 Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): requirements. PASS Enter Pass or Fail 1 DECLARATION STATEMENT ; 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 -111 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) CERTIFIED COMFORT SYSTEMS INC Responsible Person's Name: Responsible Person's Signature: Mark Hyde Mark Hyde CSLB License: Date Signed: Position With Company (Title): 906115 6/15/2012 Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? ❑ Yes ❑ No Reg: 212-A0031742A-M2500001A-0000 Registration Date/Time: 2012/06/22 17:57:03 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-21 Duct Leakage Test — Existing Duct System (Page 1 of 2) Site Address: 78-960 Carmel Circle, La Quinta CA 92253 (System Enforcement Agency: Permit Number: 1) City of La Quinta 12-682 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. 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 - existinq duct system Select one compliance method from the following four choices. 0 1. Measured leakage less than 15% of fan flow D 2. Measured leakage to outside less than 10% of Fan Flow i 0 3. Reduce leakage by 60% and conduct smoke and fix all leaks 4. Fix all accessible leaks using smoke and HERS rater verify 1 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. f'" r 0 Cooling system method: Size oft condenser in Tons 1 x,4..00 = CFM 0 Heating system m/erthod: 21.7iz Output Capacity in Thousands of Btu/hrJ, CFM ✓ ❑ Measured system airflow_ using RA3.3 airflow test procedures: CFM,` Option 1 used then: - 1 Allowed leakage = Fan Flow x 0.15 = _ CFM Actual,Leakage = _ CFM 1 Pass if Leakage Actual is less than Allowed D Pass D Fail Option 2 used then: 2 Allowed leakage = Fan Flow x 0.10 = _ CFM Actual Leakage to outside= CFM Pass if Leakage Actual is less than Allowed Pass Fail Option 3 used then: Initial leakage prior to start of work = _ CFM Final leakage after sealing all accessible leaks using smoke test = CFM 3 Initial leakage _ - Final leakage _ = Leakage reduction _ CFM ((Leakage reduction _ / Initial leakage _) x 100% _ % Reduction Pass if % Reduction >= 60% D Pass D Fail Option 4 used then: 4 All accessible leaks repaired using smoke. HERS rater must verify (No sampling). No smoke allowed to leak from system. Including ducts, plenums, air handler and door panel. Pass if all accessible leaks have been repaired using smoke D Pass D Fail 7s N Reg: 212-A0031742A-M2100001A-M21A Registration Date/Time: 2012/08/20 13:24:26 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-21 Duct Leakage Test - Existing Duct System (Page 2 of 2) Site Address: 78-960 Carmel Circle, La Quinta CA 92253 (System Enforcement Agency: Permit Number: 1) City of La Quinta 12-682 ❑ 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 CFI, Standard 62.2, and close when OA ventilation is not required, may be configured to the closed position during duct leakage testing. ❑ All supply, nd return register boots must be�sea.led to the drywall if smoke test is utilized for compliance - applies'to'duct leakage compliance option 3 (leakage reduction by.60%) and option 4ffix alf accessible leaks) described above ❑ New duct i,nstallationstzcannot utilize building cavities asfPlenums)or platform returns in lieu of ducts: ❑ Mastic and draw bands must be used in combination with cloth backed rubber adhesive duct tape to seal leaks at all new duct connections 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. • 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 -111) 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) CERTIFIED COMFORT SYSTEMS INC Responsible Person's Name: CSLB License: Mark Hyde 1906115 HERS Provider Data Registry Information Sample Group # (if applicable): 334944 ❑ tested/verified dwelling 0 not-tested/verified dwelling in la HERS sample group HERS Rater Information CaICERTS Certificate # CC1-1798665537 HERS Rater Company Name: Desert H.E.R.S. Raters Responsible Rater's Name: Responsible Rater's Signature: Michael Hyde Michael Hyde Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 7/23/2012 CC2005602 Reg: 212-A0031742A-M2100001A-M21A Registration Date/Time: 2012/08/20 13:24:26 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 5) Site Address: Enforcement Agency: Permit Number: 78-960 Carmel Circle, La Quinta CA 92253 1 City of La Quinta 12-682 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 Supplv 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 y 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 land 2 is a pass. ) Enter Pass or Fail ✓ ❑ Pass ✓ [3 Fail STMS - Sensorron the, Evaporator Coil.._. System Name'or Identification/Tag"] f .,.+,•/. I,, , j ` 1, -'tet I - / ` it - r ) ` The sensor is factory installed, or field installed according to manufacturer's The sensor is factory" installed, orjfield installed according to manufacturer's 3 (0'Ye,s ❑ specifications, or is"installed by methods/specifications approved bytheExecutive �E { Director. 4 p Yes I (, ))t G ❑.No The sensor wire is terminated.with a standard mini plug suitable for connection to a,,, digital thermometer. Thesensor mini plug is accessible to the installing,technician`,�,_" ❑ Yes ❑ No digital thermometer. The sensor mini plug is accessible to the installing technician and the HERS rater,without changing the airflow through the condenser coil 5 Yes----°' ti ❑ No When attached to a digital thermometer, the sensor provides an indication of the ❑ Yes -M -❑ w When attached to a digital thermometer, the sensor provides an indication of the 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 ✓ ❑ Pass ✓ ❑ Fail applicable. Otherwise enter Pass or Fail STMS - Sensor on the Condenser Coil System Name or Identification/Tag I 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 ❑ 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 ✓ p N/A ✓ ❑ Pass ✓ ❑ Fail applicable. Otherwise enter Pass or Fail Reg: 212-A0031742A-M2500001A-M25A Registration Date/Time: 2012/08/20 13:26:26 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5) Site Address: Enforcement Agency: Permit Number: 78-960 Carmel Circle, La Quinta CA 92253 1 City of La Quinta 12-682 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 Therm couple;Calibratiiioon 1'Y System Location or Area Served Whole House Outdoor Unit Serial # Outdoor Unit Make Outdoor Unit Model Nominal Cooling Capacity Btu/hr Date of Verification , Calibration'of Diagnostic Instruments Date of Refrigerant Gauge Calibration System 1 (must be re -calibrated monthly) Date of Therm couple;Calibratiiioon 1'Y must be re calibrated monthly) measureo iemperatures�(-;11-) I/ 1 X71 1 f 1 % c• System Name or Ide,ntification/TagE System 1 3 - 1'Y Supply (evaporator leaving) air dry-bulb temperature (Tsupply, db) ) Return (evaporator'entering) air dry-bulb temperature (Treturn, db) I r Return (evaporator entering) air wet -bulb temperature (Treturn, wb) t Evaporator saturation temperature (Tevaporator, sat) Condensor saturation temperature (Tcondensor, sat) Suction line temperature (Tsuction) Liquid Line Temperature (Tliquid) Condenser (entering) air dry-bulb temperature (Tcondenser, db) b Reg: 212-A0031742A-M2500001A-M25A Registration Date/Time: 2012/08/20 13:26:26 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5) Site Address: Enforcement Agency: Permit Number: 78-960 Carmel Circle, La Quinta CA 92253 City of La Quinta 12-682 Minimum Airflow Requirement Temperature Split Method Calculations for determining Minimum Airflow Requirement for Refrigerant Charge Verification. The temperature split method is specified in Reference Residential Appendix RA3.2. System Name or Identification/Tag Calculate: Actual Temperature Split = Treturn, db - Tsupply, db Target Temperature Split from Table RA3.2-3 using Treturn, wb and Treturn, db Calculate difference: Actual Temperature Split - Target Temperature Split = Passes if difference is between -4°F and +4°F or, upon remeasurement, if between -4°F and -100°F Enter Pass or Fail Note: Temperature Split Method Calculation is not necessary if actual Cooling Coil Airflow is verified using one of the airflow measurement procedures specified in Reference Residential Appendix RA3.3. If actual cooling coil airflow is measured, the value must be equal to or greater than the Calculated Minimum Airflow Requirement in the table below. Calculated MinimumrAirflow Requirement (CFM) = Nominal Cooling Capacity (ton) X 300 (dm/ton) . - • - ... System N r Ide 1ification/Tag'17 M .__.-__ r. Calculated Minimum Airflo/w,Requirepllm��ent (CFM) ! - i Measured Airflow using RA3 3 procedures (CFM) Passes if measured airflow is greater than or equal ' to the calculated minimum airflow requirement. _. ---� Enter Pass or Fail Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for fixed orifice metering device systems 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-A0031742A-M2500001A-M25A Registration Date/Time: 2012/08/20 13:26:26 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: 78-960 Carmel Circle, La Quinta CA 92253 City of La Quinta 12-682 Subcooling Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag Calculate: Actual Subcooling = Tcondenser, sat - Tliquid Target Subcooling specified by manufacturer Calculate difference: Actual Subcooling - Target Subcooling = System passes if difference is between -4°F and +4°F } ` ' ' Enter Pass or Fail Metering Device Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or 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) e allowable superheat range System.passes4 actual superheat is'MaFail' } ` ' ' Enter r Reg: 212-A0031742A-M2500001A-M25A Registration Date/Time: 2012/08/20 13:26:26 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: 78-960 Carmel Circle, La Quinta CA 92253 City of La Quinta 12-682 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 fir HERS Provider Data Registry Information Sample Group # (if applicable): 334944 System meets all refrigerant charge and airflow 0 not-tested/verified dwelling in la HERS sample group requirements. HERS Rater Company Name: Desert H.E.R.S. Raters Responsible Rater's Name: Responsible Rater's Signature: Enter Pass or Fail Michael Hyde Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 7/23/2012 CC2005602 DECLARATION STATEMENT • I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. • I am the certified HERS rater who performed the verification services identified and reported on this certificate (responsible rater). • The installed feature, material, component, or manufactured device requiring HERS verification that is identified on this certificate (the installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified on the Certificate(s) of Compliance (CF -1R) approved by the local enforcement agency. • The information reported on applicable sections of the Installation Certificate(s) (CF -6R), signed and submitted by the person(s) responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -1R) approved by the enforcement agency. Builder or Installer information as shown on the Installation Certificate (CF -6R) r t CERTIFIED COMFORT SYSTEMS INC Responsible Person's Name: " i fir HERS Provider Data Registry Information Sample Group # (if applicable): 334944 ❑ tested/verified dwelling 0 not-tested/verified dwelling in la DECLARATION STATEMENT • I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. • I am the certified HERS rater who performed the verification services identified and reported on this certificate (responsible rater). • The installed feature, material, component, or manufactured device requiring HERS verification that is identified on this certificate (the installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified on the Certificate(s) of Compliance (CF -1R) approved by the local enforcement agency. • The information reported on applicable sections of the Installation Certificate(s) (CF -6R), signed and submitted by the person(s) responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -1R) approved by the enforcement agency. Builder or Installer information as shown on the Installation Certificate (CF -6R) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) CERTIFIED COMFORT SYSTEMS INC Responsible Person's Name: CSLB License: Mark Hyde 1906115 HERS Provider Data Registry Information Sample Group # (if applicable): 334944 ❑ tested/verified dwelling 0 not-tested/verified dwelling in la HERS sample group HERS Rater Information CaICERTS Certificate # CCl-1798665537 HERS Rater Company Name: Desert H.E.R.S. Raters Responsible Rater's Name: Responsible Rater's Signature: Michael Hyde Michael Hyde Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 7/23/2012 CC2005602 Reg: 212-A0031742A-M2500001A-M25A Registration Date/Time: 2012/08/20 13:26:26 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010