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12-0818 (SFD)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: .12-0000.0818 Property Address: 81894 SEABISCUIT WY APN: 767-200-999-33 -312023- Application description: DWELLING - SINGLE FAMILY Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 185633 Applicants �W BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: . DESERT CHEYENE, INC. 78401 HIGHWAY 111, STE. X DETACHED LA QUINTA, CA -92253 Architect or Engineer: Contractor: lip GJH DEVELOPMENT INC 27636 YNEZ ROAD C7#1 TEMECULA CA 92591if VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 7/30/12 �AHA 2V X011 (760)578-3545 AJC Lic. No.: 916227 cIrY0rq INTA FINANCE DEPT: LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed -under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License Class: B License No.: 916227 Date: Contractor: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: (_ 1 I, 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 theon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State Lic n e Law.l. (_ 1 I am exempt under Seca , B.&P. .or this reason ate: CONSTJUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a c nstruction 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 WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: _ 1 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 EXEMPT t Policy Number EXEMPT I certify that, in the ormance of the work for which this permit is issued, 1 shall not employ any person in any man so as to become subject to the workers' compensation laws of California, and agree that, if I 11ould become subject to the workers' compensation provisions of Section y .3700 of the Labor de, I shall forthwith comply with those provisions. WARNING: FAILURE TO SECURE RKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMI AL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITIO 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 appl' ation becomes null and void if work is not commenced within 180 days from date of issuance 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 above information is correct. I agree to comply with all city and county ordinances and state laws relating to b 'ng construction, and hereby authorize representatives of this Wtonern the above-mentioned grope for inspection purposes. ate: ture (Applicant or Agent): Application Number . . . . . 12-00000818 Structure Information Construction Type . . . . . TYPE V - NON RATED Occupancy Type DWELLG/LODGING/CONG <=10 Flood Zone . . . . NON -AO FLOOD ZONE Other struct info ., CODE EDITION 2010 CBC # BEDROOMS 3.00 FIRE SPRINKLERS YES GARAGE SQ FTG 634.00 PATIO SQ FTG 263.00 NUMBER OF UNITS 1.00 "1ST FLOOR SQUARE FOOTAGE 2863.00 "Permit . . . BUILDING PERMIT Additional desc.. Permit Fee . . . 940.50 Plan Check Fee 611.33 Issue Date . . . . Valuation 185653 Expiration Date 1/26/13 Qty Unit Charge Per Extension BASE FEE 639.50 86.00 3.5000 THOU BLDG 100,001-500,000 301.00 Permit . . . MECHANICAL Additional desc . Permit Fee 90.00 Plan Check Fee 22..50 Issue Date Valuation 0 Expiration Date 1/26/13 Qty Unit Charge Per Extension BASE FEE 15.00 2.00 9.0000 EA MECH FURNACE <=100K 18.00 2.00 9.0000 EA MECH B/C <=3HP/100K BTU 18.00 5.00 6.5000 EA MECH VENT FAN .32.50 1.00 6.5000 ---------------------------------------------------------------------------- EA MECH EXHAUST HOOD 6.50 Permit . . . ELEC-NEW RESIDENTIAL Additional desc . Permit Fee 127.89 Plan Check Fee 31.97 Issue Date Valuation . . . . 0 Expiration Date 1/26/13 Qty Unit Charge Per Extension BASE FEE 15.00 2863.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 100.21 LQPERMIT Application Number 12-00000818 Permit ELEC-NEW RESIDENTIAL Qty Unit Charge Per Extension 634.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL 12.68 Permit . . . PLUMBING Additional desc . Permit Fee 172.50 Plan Check Fee 43.13 Issue Date Valuation . . . . 0 Expiration Date 1/26/13 Qty Unit Charge Per Extension BASE FEE 15.00 17'.00 6.0000 EA PLB FIXTURE 102:00. 1.00 15.0000 EA PLB BUILDING SEWER 15.00 1.00 7.5000 EA PLB WATER HEATER/VENT 7.50 1.00 3.0000 EA PLB WATER INST/ALT/REP 3.00 1.00 9.0000 EA PLB LAWN SPRINKLER SYSTEM 9.00 8.00 .7500 EA PLB GAS PIPE >=5 6.00 .1.00 15.0000 EA PLB GAS METER 15..00 Permit GRADING PERMIT 'Additional desc Permit Fee 15.00 Plan Check Fee .00 Issue Date Valuation . . 0 Expiration Date 1/26/13 Qty Unit Charge Per Extension BASE FEE 15.00 .-------------------------------------------------------------------------- Special Notes and Comments I— SFD .- LOT 33, PLAN.3RB, 2863 SF. PERMIT DOES NOT INCLUDE POOL, SPA, BLOCK WALLS OR DRIVEWAY APPROACH. 2010 CODES. ---------------------------------------- Other Fees . . . . . ----------------------------------- . . . . BLDG STDS ADMIN (SB1473) 8.00 DIF COMMUNITY CENTERS -RES 104.00. DIF CIVIC CENTER - RES 1089.00 ENERGY REVIEW FEE 61.13 DIF FIRE PROTECTION -RES 612.00 DIF LIBRARIES - RES 334.00 MULTI -SPECIES (MSHCP) FEE 1254.00 DIF PARK MAINT FAC - RES 51.00 DIF PARKS/REC - RES 1773.00 STRONG MOTION (SMI) - RES 18.56 DIF STREET MAINT FAC -RES 158.00 LQPERMIT Application Number . . . . . 12-00000818 ---------------------------------------------------------------------------- Other Fees . . . . . . DIF TRANSPORTATION - RES 3592.00 Fee summary Charged Paid Credited Due -_ -- - - - - - - - - - - - - -- - - - --- -- ------- Permit Fee Total 1345.89 .00 .00 1345.89 Plan Check Total 708.93 ob .00. 708.93 Other Fee Total 9054.69 .00 .00 9054.69 Grand Total .11109.51 .00 .00 1,1109.51 c J LQPEPMIT Riverside County Fire Department .Fire Protection Planning Section Riverside Office: 2300 Market St., Ste. 150, Riverside, CA 92501 Ph. (951)955.-4777 Fax (951) 955.4886 Murrieta Office: 39493 Los Alamos Rd., Ste A. Murrieta, CA 92563 Ph. (951) 600.6160 Fax (951) 600-6164 , Palm Desert Office: 77-933 Las Montanas Rd., # 201 Palm Desert, C4 92211-4131 Ph. (760) 863.8886(760) 863-7072 Fire Department Clearance/Release Date: To: [ I Qv iA yt l l - Fax: Tract/Parcel Map #: Perm it/Lot #: 6 C_ Job Site Address: I -' q Final For Recordation Release For Building Permit(s) Shell Final Only (No Tenant) kicea Final For 9eeep6rrcy Building Plan Check Fees Paid Building Plan Check Fees Not Paid Other Fees Fees Not Required If you should have any questions, please contact the appropriate Riverside County Fire Protection Planning office for further assistance. Autho ing Signature For Release ' Iso Print Name . Form C — Revised 10/3/2012 Building Permit Number. Project Description: SFR Exempt 0 (Materials may contain hazardous wastes and are not subject to recycling provisions) Construction Debris Management Plan Plan Submittal Dat Job Site Addros Owners Name Number, Street, or PO Be City, State, Postal Cod Owner's Phone Numbs Owner's E -Mail Addros Project Manager's Nem Project Managers Phone Numbi Project Managers E-mail Addres Wider / Contraeto Number, Street or PO Ba City, State, Postal Cod Project Square Footag City Approval By Date of City Approval latedals To Be Discarde Product Trash Asphalt BrjckBlock Cardboard Commingled Concrete Drywall Donated / Reuse* 8/8/2012 81807 Ave. 52 John Pedalino 78401 Hwy 111, Unit La Quinta, CA 92253 760.678-6915 Silver Castro 619.495-4624 johnOthelandatawarda.com Desert Cheyenne, Inc. 78401 Hwy 111, Unit X La Quanta, CA 92253 8,326 ---� ble Product Masonry (broken) Plaster Scrap Metal Tile (floor) Tile (roof) Wood Landscape Debris I *Describe Items II Totals: Recycle Trash Projected Diversion: 27.8 15.8 85.7•!. t understand it Is the property ownses responsibility to submit copies of weight tickets or receipts to the District Environmental Coordinator as these hauls occur. l hereby certify that completion, Implementation and adherence of the Debris Management Plan (DMP) for the above named project shall guarantee that at least 60% of the jobsite waste is diverted from landfilling. The remaining material will be recycled or roused. I will divert, for recycling or rause, remaining materials generated from the first day of the project through the completion of the project In accordance with this plan. This DMP Is Issued in the name of the property owner(a) and shall remain their property throughout the constriction and/or demolition project A contractor as gas ent of the owner may obtain a DMP for the owner. However, the DMP Is still issued In the name of the property own ) e owner retains Iegat responsibility for ensuring that the provisions of the DMP aro adhered to. The property owner(:) d g contractor shall be kept Informed of the diversion progress through bl-monthly reports. K self -hauling, all refuse ma this project alto must be taken to an approved recyc7,71 r station. Or Owner / Developer / Project Maiiager / Superintandant Date �11 I INSTALLATION CERTIFICATE CF -6R -ENV -01 Envelope — Insulation; Roofing; Fenestration (Page 1 of 3) Site Address: LOT 33 RANCHO SANTANA, LA QUINTA, Enforcement Agency: Permit Number: CA %J Sty /f more than one person has responsibilityfor installation of the items on this certificate, each person shall prepare and sign a certificate applicable to the portion of construction for which they are responsible; alternatively, the person with chief responsibilityfor construction shall prepare and sign this certificate for the entire construction. All applicable Mandatory Measures with check boxes require to be checked to ensure the mandatory measures have been met. Description of Insulation 1. RAISED FLOOR Material: Brand Name: Thickness (inches): Thermal Resistance (R -Value): U §150(d): Minimum R-13 insulation in raised wood -frame floor or equivalent U -factor. 2. SLAB FLOOR/PERIMETER Material: Brand Name: Thickness (inches): Thermal Resistance (R -Value): Perimeter Insulation Depth (inches): C;l §150(1): Water absorption rate for the insulation material alone without facings is no greater than 0.3%; water vapor permeance rate is no greater than 2.0 perm/inch and shall be protected from physical damage and UV light deterioration. 3. EXTERIOR WALL a. Insulation Type (e.x. Batt, Loose Fill, Spray Foam) a. Thermal Resistance (R -Value): R-13 b.. Insulation Type (e.x. Batt, Loose Fill, Spray Foam) b. Thermal Resistance (R -Value): Brand: CERTAINTEED_ 4; Spray/Loose fill) Installed Actual Thickness Spray/Loose fill) ",Contractor's min installed weight/ft' Ib (inches): Manufacturer's installed weight per square foot to achieve Thermal Resistance (R -Value) I 'I § 150(c): Minimum R-13 insulation in wood -frame wall or equivalent U -factor. Exterior Foam Sheathing (rigid Insulation) Material: Thickness f inches) 4. FOUNDATION WALL Material: Thickness (inches): 5. -CEILING -Batt or Blanket Type: BATT Brand Name: Thermal Resistance (R -Value) : Brand Name: Thermal Resistance (R -Value): h Brand Name: CERTAINTEED Loose Fill Type: • CELLULOSE Thermal Resistance (R -Value): R-38 Spray Foam Type: Brand Name: CERTAINTEED Installed Actual Thickness (inches): 12" Contractor's min installed weight/ft' Ib Manufacturer's installed weight ner soua.re foot to achieve Thermal Resistance (R -Value): I §150(a): Minimum R-19 insulation in wood -frame ceiling or equivalent U -factor. 6. ATTIC ROOF INSULATION AND/OR ATTIC RADIANT BARRIER Material: Brand Name: Material: Brand Name: Thickness (inches): Thermal Resistance (R -Value): 0 §118(a): Insulation installed meets Standards for Insulating Material. I ' I '§ I50(g): Mandatory Vapor barrier installed in Climate Zones 14 or 16. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF -6R -ENV -01 Envelope — Insulation; Roofing; Fenestration (Page 2 of 3) Site Address: Enforcement Agency: Permit Number: Description of R ofing Products CRRC Product ID Manufacturer Product Roof Roof Product Initial Solar Aged Solar Thermal Number' Information Brand/Model Type Area Slope Weight' Reflectance Refle nqe Eminance 2 3 D 4 �l a I. The CRRC Product ID Number can be o ained from the Cool RooJRating Council's Rated Product D' ectory at ww. coolroofs. org/products/search. php 2. The weight in lbs per square feet of the roo g product being installed 3. Check box if the Aged Reflectance is a calcul ed value using the equation below, footnote 4. 4. !f the aged reflectance is not available in the of Roof Rating Council's Rated Product D' ectory then use the initial reflectance value from the directory and use the equation (0.2+0.7(pi„i,ior — .2) to obtain a calculated aged value. 9 n CHECK APPLICABLE BOX BELOW IF EXEMP ROM THE ROOFING PRODUCT " OOL ROOF" REQUIREMENT. - CI The roof area covered by building integrated ph ovoltaic panels and building ' tegrated solar thermal panels are exempt from the above Cool Roof criteria. Ll Roof constructions that have thermal mass over th of membrane with weight of at least 25 Ib/ is exempted from the above Cool Roof criteria. To apply Liquid Field Applied Coatings, the coating must b applied wito minimum dry mil thickness of20 mils across the entire roofsurface and meet minimum performance requirements listed in §118()3 Table 18-C. Select the a_pplivable coatis 0 Aluminum -Pigmented Asphalt Roof Coating 0 VeniAht-Based Roof Coating I O Other 9 ❑ CRRC-1 Label Attached to CF -611 (Note if no CRRC-1 label is available, this compliance metho t be used and another method is required to meet compliance). FEN ESTRATION/GLAZING Item ManufacturerBrand Name (GROUP LACE RODUCTS Product U- factor uct /SHC' 4 of Panes RC Ce iedl' 2 Total Quantity of Like Product (O tional) Area ft or Add. Exterior Shading Dev. Overhang Comments/ Location/ Special Features 2 3 4 5 6 7. 8. I. Use valuesfrok a fenestration product's NFRC Certified Label Forfenestration products without an NFRC label, use th efault values from Section 116, Table 116-A and 116-Blefthe 2008 Energy Efficiency Standards. 2. NFRC Label Certificates shall not be removed until the building inspector has verified the efficiency. Enter Yes or No. O §1 16(a)]: Doors and windows between conditioned and unconditioned spaces designed to omit air ieaKage. L..I § 116(a)2 and 3: Actual fenestration products installed are equivalent to or have a lower U -factor and/or a lower SHthan that specified on the Certificate of Compliance (Form CF -1 R). O § 116(a)d: Fenestration products (except field -fabricated windows) have a label listing the certified U -Factor, certified S ar Heat Gain Coefficient (SHGC), and infiltration that meets the requirements of §10-111(a) ❑ §117: Exterior doors and windows weather-stripped; all joints and penetrations caulked and sealed. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF -6R -ENV -01 Envelope — Insulation; Roofing; Fenestration (Page 3 of 3) Site Address: LOT 33 RANCHO SANTANA, LA QUINTA, Enforcement Agency: Permit Number: CA DECLARATION STATEMENT • 1 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 -1 R) 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. 1 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 nwner nt accuoancv. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) EMPIRE INSULATION, INC. Responsible Person's Name: JOHN MIRANDA Responsible Person's Signature: CSLB License: 860072 Date Signed: 12/10/12 Position With Company (Title): DUCTION MANAGER 2008 Residential Compliance Forms August 2009 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF -4R -ENV -20 Building. Envelope Sealing + (Page 1 of 1) Site Address: Seabiscuit Way, La Quinta CA 92253 (System Enforcement Agency: Permit Number: )1-894 City of La Quinta 12-818 h 1068 ® tested/verified dwelling (cfm). ' I CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF -4R -ENV -20 Building. Envelope Sealing + (Page 1 of 1) Site Address: Seabiscuit Way, La Quinta CA 92253 (System Enforcement Agency: Permit Number: )1-894 City of La Quinta 12-818 h Buildinq EnveloDe Sealinq Diagnostic Testing Results CFM50H = the measured airflow in cubic feet per minute (cfm) at 50 pascals for the dwelling with air distribution registers unsealed. SLA = 3.819 x (CFM50 H / Conditioned Floor Area in ft2) per Residential ACM Manual Equation R3-16 Responsible Person's Name: Building Envelope Leakage CFM50H as measured using a blower door diagnostic device Greg Herington ' 1. Enter the blower door leakage target CFM50H value for compliance from the CF -1R 1068 ® tested/verified dwelling (cfm). ' 2. Enter the blower door leakage minimum CFM50H value corresponding to 1.5 SLA 534 HERS Rater Company Name: from the CF -1R (cfm). / 3. Enter the measured CFM50H value from the blower door test (cfm) 990 4. The leakage test passes if the measured envelope leakage CFM50H value from row is 3 ® ❑ less than or equal to the value required for compliance from row 1, otherwise the test Pass Fail fails. check/enter Pass or Fail 5. If measured CFM50H from row 3 is less than the minimum CFM50H value corresponding to Y.5 1.5 SLA from row 2: < >_ .5 check/enter < 1.5 SLA, otherwise check/enter >_1.5 SLA SLA* SLA *Advisory note to builder and enforcement agency: If row 5 indicates "< 1.5 SLA", it is critical to ensure that combustion and solid -fuel burning appliances in the dwelling are provided with adequate combustion and ventilation air and vented in accordance with manufacturers' installation instructions and all applicable codes as specified by ASHRAE Standard 62.2 Section 6.4. Additional information about compliance with this requirement is given in Section 4.6.5 of the Residential Compliance Manual under the topic of Combustion and ' Solid -Fuel Burning Appliances. f A � G ' ~• t �� - 4 �r+-e. Fy ,... `q r�,...p. 4r af�..►..,.t,. +..-""'..�,tz..-�,,,� . 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 RAZ 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 -611), signed and submitted by the persoh(s) responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -111) approved by the enforcement agency. I' . Builder or Installer information as shown on the Installation Certificate (CF -611) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) , GJH Development Inc Responsible Person's Name: CSLB License: Greg Herington ' N/A HERS Provider Data Registry Information Sample Group # (if applicable): N/A ' ' ® tested/verified dwelling ❑ not-tested/verified dwelling in la HERS sample group HERS Rater Information CalCERTS Certificate # CC1-1798706086 HERS Rater Company Name: BCI Testing - Responsible Rater's Name: Responsible Rater's Signature: William Irvine William Irvine Responsible Rater's Certification Number w/ this HERS Provider: CC2004075 Date Signed: 12/4/2012 ' k Reg: 210-N0000632A-E2000033A-E20A Registration Date/Time: 2012/12/05.18:43:_09 HERS Provider: CalCERTS, Inc., 2008 Residential Compliance Forms A 2009 ugust , r . ' _ Y k Reg: 210-N0000632A-E2000033A-E20A Registration Date/Time: 2012/12/05.18:43:_09 HERS Provider: CalCERTS, Inc., 2008 Residential Compliance Forms A 2009 ugust , r . ' CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF -411 -ENV -21 Quality Insulation Installation (QII) —Framing Stage Checklist (Pagel of 2) Site Address: Enforcement Agency:. Permit Number: ' 81-894 Seabiscuit Way, La Quinta CA 92253 City of La Quinta 12-818 Quality Insulation Installation (QII) - Framing Stage Checklist 1. y Air barrier installation and preparation for insulation must be done at framing stage before insulation is installed. If there are any "No" answers, rows not filled out, or a signature missing then this is not a valid form and cannot be accepted by the building department or HERS rater., SPF insulation can be considered an air barrier when the bottom and top plates of vertical framing and both ends of horizontal framing, including band and rim joists, are sprayed to completely fill the cavity adjacent to and in contact with the framing to a distance of 5.5 inches away from the framing for open cell SPF (ocSPF) or 2.0 inches away from the framing for closed cell SPF (ccSPF). SPF can be considered as an air barrier with less than the above thickness when a product data or specification sheet is provided that shows the product meets an air permeance no greater than 0.02 L/s-m2 at 75 Pa pressure differential when tested in accordance to ASTM E2178 or ASTM E283. All structural framing areas shall be insulated in a manner that resists thermal bridging of the assembly separating conditioned from unconditioned space. Structural bracing, tie -downs, and framing of steel, or specific framing used to meet structural requirements of the CBC are allowed and must be insulated. These areas shall. be called out on the . building plans with diagrams and/or specific design drawings indicating the R -value of insulation and fastening. method to be used. FLOOR AIR BARRIER ❑ e ❑ leo ® IQA All gaps in the raised floor to unconditioned space or to outside larger than 1/8" filled with foam or caulk. (NA'if SPF meets conditions above) a ,' ® NA 1. y Air barrier installation and preparation for insulation must be done at framing stage before insulation is installed. If there are any "No" answers, rows not filled out, or a signature missing then this is not a valid form and cannot be accepted by the building department or HERS rater., SPF insulation can be considered an air barrier when the bottom and top plates of vertical framing and both ends of horizontal framing, including band and rim joists, are sprayed to completely fill the cavity adjacent to and in contact with the framing to a distance of 5.5 inches away from the framing for open cell SPF (ocSPF) or 2.0 inches away from the framing for closed cell SPF (ccSPF). SPF can be considered as an air barrier with less than the above thickness when a product data or specification sheet is provided that shows the product meets an air permeance no greater than 0.02 L/s-m2 at 75 Pa pressure differential when tested in accordance to ASTM E2178 or ASTM E283. All structural framing areas shall be insulated in a manner that resists thermal bridging of the assembly separating conditioned from unconditioned space. Structural bracing, tie -downs, and framing of steel, or specific framing used to meet structural requirements of the CBC are allowed and must be insulated. These areas shall. be called out on the . building plans with diagrams and/or specific design drawings indicating the R -value of insulation and fastening. method to be used. FLOOR AIR BARRIER ❑ e ❑ leo ® IQA All gaps in the raised floor to unconditioned space or to outside larger than 1/8" filled with foam or caulk. (NA'if SPF meets conditions above) P . P ® NA All openings in the raised floor including second floors, such as under a tub where the drain ' penetrates the floor are sealed, (NA if slab on grade) WALLS AIR BARRIER Ire's ,ITo Rw ll -gaps to outside larger than 1//•88""lfille�o am or caulk. (NA if SPF meets conditions above) AR f s, All,jopenings in top'and bottom plate to the outside in interior and exterior, walls, including holes' drilled for electrical and plumbing larger than 1/8" filled with foam or caulk. -(NA if SPF meets..., conditions above) .1 .. .. Yes o� r++ : � s, I Rope caulk, foam gasket, or caulking bead under exterior sole plate of the home, f �l� ti t:`. °► st i 1 c t y ?.� L°A�Jr .I ® e y I oo' ~� �. All gaps'around windows and"doors `caulked or;foamed,.LoW expanding foam! recorri mended, if allowed ' by window manufacturer. (Stuffing with fib&glass'not acceptable) ATTIC INSPECTION ` r ® Yes ❑ &o ❑ 19 Attic rulers appropriate to the material installed are evenly distributed throughout attic to verify depth. (NA if SPF or batt) ® Yes No ❑ NA Number of rulers installed 12 Attic area (sgft) 2863 - 250 = 12 minimum number of rulers . installed. Must round up. (NA if SPF or batt) ❑ NA ALL rulers visible from attic access.(NA if SPF or batt) ' ® Yes ❑ No 1 9 Eave vents baffles installed at all eave vents to prevent air movement under or into insulation. (NA if JSPF) - CEILING AIR BARRIER t - es p 0 All draft stops in place to form a continuous ceiling air barrier no gaps larger than 1/8". (NA if SPF meets conditions above) ® Y ❑ NA All dropped ceilings/soffits covered with hard covers. Gaps around or in the hard cover larger than 1/8" filled with foam or caulk. (NA if no drops) Openings around flue shafts fully sealed with flashing and caulked. (NA'if no flue shafts) .r• t •{ ., Reg: 210-N0000632A-E2100035A-E21A Registration Date/Time: 2012/12/05 18:44:52 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms May 2012 L ' t •{ ., Reg: 210-N0000632A-E2100035A-E21A Registration Date/Time: 2012/12/05 18:44:52 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms May 2012 •{ ., Reg: 210-N0000632A-E2100035A-E21A Registration Date/Time: 2012/12/05 18:44:52 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms May 2012 ,9 [ , - r 1 1 i • Y ERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF -4R -ENV -2 uality Insulation Installation (QII) - Framing Stage Checklist (Page 2 of lite Address: Enforcement Agency: Permit Number: I1-894 Seabiscuit Way, La Quinta CA 92253 City of La Qui nta 12-818 Y + , - r 1 ' ❑ NA Penetrations through the ceiling air barrier from electrical boxes in the ceiling, fire alarm boxes, etc. sealed with caulk or foam. (NA if no penetrations) PAll If insulation is to be installed at subfloor then subfloor has no gaps over 1/8". Air barrier installed at . joists in garage to house transition (between floors). Use of SPF meeting conditions above as the air „ barrier satisfies the requirement to seal the gaps. j''� 1 e duct chases, fireplace chases, and double walls sealed air tight at the ceiling level. All gaps into shafts larger than 1/8" filled with foam or caulk (NA if none of the above or SPF meets conditions e P NA Piping shaft openings fully sealed and.caulked. (NA if no pipe shafts) - P �''� Po ❑ NA Penetrations through the ceiling air barrier from electrical boxes in the ceiling, fire alarm boxes, etc. sealed with caulk or foam. (NA if no penetrations) PAll If insulation is to be installed at subfloor then subfloor has no gaps over 1/8". Air barrier installed at . joists in garage to house transition (between floors). Use of SPF meeting conditions above as the air „ barrier satisfies the requirement to seal the gaps. j''� 1 e duct chases, fireplace chases, and double walls sealed air tight at the ceiling level. All gaps into shafts larger than 1/8" filled with foam or caulk (NA if none of the above or SPF meets conditions es o HERS Rater Information CalCERTS Certificate # CC1-1798706086 above) GARAGE ROOF/CEILING AIR BARRIER FOR TWO STORIES (no conditioned space over garage) ❑ Yes ❑ Imo 119 Air barrier installed at joists in garage to house transition (between floors). No gaps larger than 1/8" allowed. (NA if SPF meets conditions above) GARAGE ROOF/CEILING AIR BARRIER FOR TWO STORIES (conditioned space over garage) ❑ e P 9 If insulation is to be installed at subfloor then subfloor has no gaps over 1/8". Air barrier installed at . joists in garage to house transition (between floors). Use of SPF meeting conditions above as the air „ barrier satisfies the requirement to seal the gaps. j''� 1 e P ® NA If insulation is to be installed at ceiling of garage then ceiling and joists to the outside have no gaps . over 1/8". (NA if SPF meets conditions above or no conditioned space over garage.) r 10 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 A 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 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) Empire Insulation i CSLB License: Jennifer Carr r 10 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 A 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 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) Empire Insulation Responsible Person's Name: CSLB License: Jennifer Carr 1860072 HERS Provider Data Registry Information Sample Group # (if applicable): N/A tested/verified dwelling❑ not-tested/verified dwelling in a HERS sample group _ HERS Rater Information CalCERTS Certificate # CC1-1798706086 HERS Rater Company Name: - f BCI Testing Responsible Rater's Name: Responsible Rater's Signature: _ = William Irvine William Irvine Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 10/30/2012 CC2004075 Reg: 210-N0000632A-E2100035A-E21A Registration Date/Time: 2012/12/05 18:44:52 %HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms May 2012 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF -4R -ENV -20 Building Envelope Sealing (Page 1 of 1) Site Address: 81-894 Seabiscuit Way, La Quinta CA 92253 (New Enforcement Agency: Permit Number: System) City of La Quinta 12-818 Building Envelope Sealing Diagnostic Testing Results CF11450H = the measured airflow in cubic feet per minute (cfm) at 50 pascals for the dwelling with air distribution registers unsealed. SLA = 3.819 x (CFM50 H / Conditioned Floor Area in ft2) per Residential ACM Manual Equation R3-16 Responsible Person's Name: Building Envelope Leakage CFM50H as measured using a blower door diagnostic device Greg Herington 1. Enter the blower door leakage target CFM50H value for compliance from the CF -1R 1181 ® tested/verified dwelling (cfm). 2. Enter the blower door leakage minimum CFMSOH value corresponding to 1.5 SLA 590 HERS Rater Company Name: from the CF -111 (cfm). Responsible Rater's Name: 3. Enter the measured CFM50H value from the blower door test (cfm) 1035 4. The leakage test passes if the measured envelope leakage CFM50H value from row is 3' ® ❑ less than or equal to the value required for compliance from row 1, otherwise the test Pass Fail fails. ' check/enter Pass or Fail 5. If measured CFM50H from row 3 is less than the minimum CFM50H value corresponding to 1.5 SLA from row 2: <Y•5 21.5 check/enter < 1.5 SLA, otherwise check/enter >_1.5 SLAI SLA* SLA *Advisory note to builder and enforcement agency: If row 5 indicates "< 1.5 SIA", it is critical to ensure that combustion and solid -fuel burning appliances in the dwelling are provided with adequate combustion and ventilation air and vented in accordance with manufactures' installation instructions and all applicable codes as specified by ASHRAE Standard 62.2 Section 6.4. Additional information about compliance with this requirement is given in Section 4.6.5 of the Residential Compliance Manual under the topic of Combustion and Solid -Fuel Burning Appliances. 4 s 9111 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, rnaterial, component, or manufactured device requiring HERS verification that is identified on this certificate (the installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified on the Certificate(s) of Compliance (CF -1R) approved by the local enforcement agency. . . • The information reported on applicable sections of the Installation Certificate(s) (CF -6R), signed and submitted by the person(s) responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -1R) approved by the enforcement agency. Builder or Installer information as shown on the Installation Certificate (CF -611) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) GJH Development Inc , Responsible Person's Name: CSLB License: _ Greg Herington N/A HERS Provider Data Registry Information Sample Group # (if applicable): N/A ® tested/verified dwelling ❑ not-tested/verified dwelling in la HERS sample group HERS Rater Information CalCERTS Certificate # CC1-1798706086 HERS Rater Company Name: BCI Testing Responsible Rater's Name: Responsible Rater's Signature: William Irvine William Irvine Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: •12/4/2012 " CC2004075 Reg: 210-N0000632A-E2000034A-E20A Registration Date/Time: 2012/12/0518:43:09'•' HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms - August 2009 A CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF -4R -ENV - Quality Insulation Installation (QII) - Insulation Stage Checklist (Page 1 of 3) Site Address: Enforcement Agency: Permit Number: 81-894 Seabiscuit Way, La Quinta CA 92253 City of La Quinta 12-818 All structural framing areas shall be insulated in a manner that resists thermal bridging of the assembly separating conditioned from unconditioned space. Structural bracing, tie -downs, and framing of steel, or specialized framing used to meet structural requirements of the CBC are allowed and must be insulated. These areas shall be called out on the building plans with diagrams and/or specific design drawings indicating the R -value of insulation and fastening method to be used. SPF insulation can be considered an air barrier when the bottom and top plates of vertical framing and both ends of horizontal framing, including band and rim joists, are sprayed to completely fill the cavity adjacent to and in contact with the framing to a distance of 5.5 inches away from the framing for open cell SPF (ocSPF) or 2.0 inches away from the framing for closed cell SPF (ccSPF). SPF can be considered as an air barrier with less than the above thickness when a product data or specification sheet is provided that shows the product meets an air permeance no greater than 0.02 L/s-m2 at 75 Pa pressure differential when tested in accordance to ASTM E2178 or ASTM E283. t Closed cell and open cell manufacturers claim various R -values per inch. In California the maximum R -value that can be claimed for ccSPF is an R -value of 5.8 per inch and for ocSPF is an R -value of 3.6 per inch. Higher R -values per inch cannot be claimed even with manufacturer data. Insulation Staoe Checklist FLOOR INSULATION �r Pjj''""jj IS �""� P ® NR All floor joist cavity insulation installed to uniformly fill the cavity side-to-side and end-to-end, NO gaps. (NA if slab on grade) t PP P NA Insulation in full contact with the subfloor, NO gaps. (NA if slab on grade) Yes P ® NA Batts: cut to fit around wiring and plumbing, or split (delaminated). (NA if loose fill, SPF, or slab on grade) P w❑ Imo~ ® _19 Batts: shall be properly supported to avoid gaps, voids, and compression. (NA for other forms of insulation) , PIS ❑ Imo ❑ NA Insulationik-value same or greater than listed on CF -1R. (NA for slab on grade) P f No NA Gaps between studs largervthan 1/8" the cavity must be -filled with,msulation or foam. (NA for slab on gade)fi r• , `�-- Yes P l";(requi,�,ed f t"threquire floor cavity d fl t R-vauerom" I f CF•1R,: - eermine require 11 t D t d thickness , for ccSPFr(required R -value it /-5[8R) 4 -• Y orches), or, reiauired•thickness;for ocSPF -_• ` incs) .(NA for,otherforms of R -value /,i'3.6'= he ihsulation)r,� ',�'+ �• '4,,.- �... �;'1-%" :..+.=»� � �""�xr�"'�- 4a::�'� . � � r`� +4, r i� ' � ��'!� �° int+" �`„�'='''1�j.` WALL INSULATION ® Yes P ❑ NA Batts, loose fill mineral fiber, mineral wool, and cellulose: fills cavity and is in contact with air barrier. ocSPF: shall completely fill cavities of 2x4 inch framing or less. Cavities greater than 2x4 inch framing dimensions must be filled to the thickness calculated above. ccSPF: insulation is not required to fill the cavities of framed assemblies provided the installed ' thickness of insulation conforms to the thickness calculated above. ❑ e P ® NA Double walls and bump -outs - insulation fills the cavity or additional air barrier installed in the cavity so that the insulation fills the cavity and in contact with the air barrier. (NA if SPF meets conditions above and meets the`required R -value) ® e P j❑'j NA Insulation installed in exterior walls adjacent to tub/shower, walls under stairs, and fireplace. Insulation required to fill wall cavity. Cavity required to be air tight. (NA if none of the above) es P All gaps around windows and doors filled with insulation or filled with low expanding foam. ® Yes ❑ Imo ❑ NA Batts: no voids/depressions greater than 3/4" in ANY stud bay. (NA for other forms of insulation) ' A Imo NA Batts: voids/depressions less than 3/4" allowed as long as the area is not greater than 10% of the surface area for each stud bay. (NA for other forms of insulation) jj''jj P P ® 19 Loose Fill: no gaps or voids. Insulation completely fills the cavity. (NA for other forms of insulation)1011 - Gaps between studs larger than 1/8" the cavity must be filled with insulation or foam. .l, ' - • . ciJ' �� tea, `• L< < . _ ` .. Reg: 210-N0000632A-E2200032A-E22A' Registration Date/Time: 2012/12/06.16:51:25 HERS Provider: Ca10ERTS, CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF -4R -ENV -22 Quality Insulation Installation (QII) - Insulation Stage Checklist. (Page 2 of 3) Site Address: Enforcement Agency: Permit Number: 81-894 Seabiscuit Way, La Quinta CA 92253 City of La Quinta 12-818 es o o All Rim -joists to the outside insulated. (NA if no Rim -joists) es o o Insulation installed at corner channels, wall intersections, and adjacent to tub/shower enclosures insulated to proper R -Value. Pe o No All skylight shafts and attic kneewalls insulated with minimum R-19. (NA if no skylights, kneewalls or in conditioned attic) es o No Insulation in full contact with air barrier or wall.finish for skylight shafts and attic kneewalls. (NA if no skylight or kneewalls) ® e ❑ ISO Installed wall insulation R -value equal to or greater than what is listed on the CF -1R. e Imo ® NA SPF: insulation installed without gaps and to provide an air seal when specified as an air barrier. (NA for other forms of insulation) `s "" "" SPF: list the required wall cavity.R-value from CF -SR, R- 13.0 . Determine required thickness for ccSPF (required R -value 13.0 / 5.8R) = 2.2 inches), or required thickness for ocSPF (required R-value13.0 / 3.6 = 3,6 inches). (NA for other forms of insulation) ❑ Yes + ® NA SPF: measure thickness of wall insulation in 6 random areas. Minimum thickness for ccSPF shall be no more than!/z inch less than the required thickness listed above. Minimum thickness for ocSPF shall be no more than 1 inch less than the required thickness listed above. (NA for other forms of. insulation) CEILING/ROOF INSULATION t 1 Gaps between studs larger than 1/8" the cavity must be filled with insulation or foam. - i Batts: no gaps/voids/depressions,greaterthan 33/4 ,(NA -for other,�formsof.insulation.). ® e 'I rNA Batts: voids/depressions Jess than 3/4" allowed asllong as the area is not greater than_ 10% of the surfacetaiea for each stud bay. (NA for other forms -of insulation) j •. ,p ^---� e M s II: � gap or voids lowed NA f o er ms;o Ilation —A-- . Yes n.^+ O sr/iirt �e''1 yid� l "c •..yam e..o.'T+ ,. ....... installedt rmlfit vi `vde-t - end-to-end.. All ceiling/roof,insulation installed to uniformly fit the cavity side to side and end-to-end.. �_ .-e— Insulation in full contact with the ceiling/roof, NO gaps. .. Y £ 4 Insulation in contact with air barrier. 1P " aP Batts: cut to fit around wiring and plumbing, or split (delaminated). (NA for other forms of insulation) A® ❑ Io ❑ NA Batts taller than bottom chord must expand over the bottom chord or additional insulation installed so bottom chord not visible. (NA for other forms of insulation) P R Batts cut to fit around ALL webbing. No gaps allowed between webbing and batts. (NA for other forms of insulation) Pes Po SPF: list the required ceiling R -value from CF -1R, R- 13.0 . Determine required thickness for ccSPF (required R -value 13.0 / 5.8R) = 2,2 inches), or,required thickness for ocSPF (required R -value 13.0 / 3.6 = 13.0 inches). (NA for other forms of insulation) r es o 19 SPF:'measure thickness of ceiling insulation in 6 random areas. Minimum thickness for ccSPF shall be no more than 1/2 inch less than the required thickness listed above. Minimum thickness for ocSPF shall be no more than 1 inch less than the required thickness listed above. (NA for other forms of insulation) ®❑ Yes 0 NA HVAC Platform and Catwalks - insulated to R -value equal to ceiling R -value listed on CF -1R. If less insulation installed then called out on CF -111. (NA if no platform or catwalks) PP "NA Attic access gasketed. (NA of no attic access) �. ® e P ❑ NA Attic access insulated with rigid foam or batt insulation using adhesive or mechanical fastener. Attic access door R -value equal to ceiling R -value listed on CF -111. If less insulation installed then called out on CF -1R. (NA if no attic access) ❑ NA Recessed light fixtures covered full depth with insulation. If SPF used then other forms of insulation used to cover or enclose fixture in a box fabricated from '/z -inch plywood, 18 ga. sheet metal, 1/4 -inch hard board or drywall. SPF or other insulation then covers light fixture to full depth. (NA is , no recessed light fixtures) ■ Reg: 210-N0000632A-E2200032A-E22A Registration Date/Time: 2012/12/06 16:51:25 HERS Provider:'Ca10ERTS, l® �''� All recessed light fixtures in non conditioned space are IC rated and air tight (AT). (NA if no recessed. e I Ido 19 Ilight fixtures) t, I r1_7 ti T . ♦ � r'Y ��f �'e ,�d� � � V "fie' r•' .. • �+ ... +raj t . t �`.. ...., aP�>.; - -s.--e � j .R_ s-- " .. - • a• j . o. j Reg: 210-N0000632A-E2200032A-E22A Registration Date/Time:'.2012/12/06 16:51:25 HERS Provider: Ca10ERTS, y. CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF -4R -ENV -22 Quality Insulation Installation (QII) - Insulation Stage Checklist (Page 3 of 3) Site Address: Enforcement Agency:. Permit Number: 81-894 Seabiscuit Way, La Quinta CA 92253 1 City of La Quinta 12-818 IS o �]All No recessed light fixtures are sealed with a gasket or caulk between the housing and the ceiling. (NA if no recessed light fixtures) Yes PCeiling 1860072 insulation equal to or greater than what is listed on the CF -1R. es o 0 Loose Fill: Minimum thickness required to.meet the stated R -value listed on CF -1R. Insulation rulers visible for verifying the installed R -value for blown in insulation. (NA for other forms of insulation) ® Yes No ❑ No Loose Fill: insulation uniformly covers the entire ceiling (or roof) area from outside of all exterior walls. (NA for other forms of insulation) , ��Minimum YeS Responsible Rater's Name: Responsible Rater's Signature: Weight of Mineral -Fiber Loose -fill (Fiberglass, Rock wool) -Target R -value from CF-1R) weight from insulation bag label to meet target R -value (Ib./ftz) . Weight of insulation from coring tool (Ib). Area of coring tool (ftz). Sample weight = (Ib./ftz). Is sample weight (Ib./ftz) the same as or greater than required weight (Ib./ftz) (NA for other forms of insulation) Yes [] NO 1 No Thickness - ALL Loose -Fill Insulation -Target R -value (from CF -1R) 38 . Required thickness from insulation bag label to meet Target R -value for (Installed Thickness 10.59 (in)), and (Settled Thickness 10,27 (in)). Average Installed thickness 10.3 (in). Is Installed Thickness the same as or greater than Required Thickness? (NA for other forms of insulation) 4 - GARAGE ROOF/CEILING INSULATION FOR TWO STORIES(no conditioned space over garage) ❑ e �''� ao ®Insulation NA installed at joists against the air barrier in the garage to house transition. All wall I insulation requirements above must be met. (NA if.conditioned space over garage). GARAGE,ROOF/CEILING INSULATION FOR TWO STORIES(conditioned space over garage) P` P a - ®-- R If insulation is to be installed at subfloor then the insulation must also be installed at joists against the air barrier ir.the garage to house transition. All ceiling and wall insulation requirements above must be met. (NA if,no,conditioned space over garage).: es o. � � Iflinsulation is to be installed at"ceiling of garage then the.joists,tothe outside must be'insulated and all!the insulation requirements listedjabovemust,be met ,,(NA°if no eonditloned'space over garage). 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 agencv. Builder or Installer information as shown on the Installation Certificate (CF -61R) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) - Empire Insulation Responsible Person's Name: CSLB License: Jennifer Carr 1860072 HERS Provider Data Registry Information Sample Group # (if applicable): N/A ®tested/verified dwelling iRnot-tested/verified dwelling inERS sample group, HERS Rater Information CalCERTS Certificate # CC1-1798706086 HERS Rater Company Name: BCI Testing Responsible Rater's Name: Responsible Rater's Signature: William Irvine William Irvine Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 12/4/2012 CC2004075 Reg: 210-N0000632A-E2200032A-E22A Registration Date/Time: 2012/12/06 16:51:25 HERS Provider: Ca10ERTS, I CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-20 Duct Leakage Test - Completely New or Replacement Duct System (Page 1 of 2) Site Address: 81-894 Seabiscuit Way, La Quinta CA 92253 (System Enforcement Agency: Permit Number: 1) City of La Quinta 12-818 Enter the Duct System Name or Identification/Tag: System 1 Enter the Duct System Location or Area Served: bedrooms Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the dwelling. This certificate is required for compliance for completely new duct systems installed in new dwelling construction, and also for completely new or replacement duct systems in existing dwellings. 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. Duct Leakage Diagnostic Test - completely new or replacement ducts stem Enter a value for the Allowed Leakage (CFM) for the duct system leakage verification. The value entered must be the VLLDCS criteria or one of the three calculated leakage rates described below. Verified Low Leakage Ducts in Conditioned Space (VLLDCS) Compliance Credit. If compliance credit for Allowed verified low leakage ducts in conditioned space is shown in the special features section of the CF -1R, the Leakage leakage to outside test method must be used to verify duct leakage (refer to RA3.1.4.3.4), and 25 CFM must (CFM) be entered for Allowed Leakage.. , Allowed leakage calculation - (select one calculation method from this section). Use 6% (leakage factor = 0.06) for calculations. When utilizing Low Leakage Air Handler (LLAH) credit, the allowed duct leakage may be specified by the CF -1R to, be less than 6%, in which case the user-specified leakage rate must be used in the calculations below. For example, if the user-specified leakage (specified as a percentage of fan airflow) is reported•on the CE 111`as 3%, thenluse aleakage factor of 0.03 in the calculations below. ® Cooling system-method:.,.� Nominal capacity o denser in Tons q 1+400'x leakrfa for —Ao 6 CFM, a . t� ❑ Heating system method: "`�G, �. '' it ^'`'�-- 21.7 x Output Capacty.in Thousands of Btu/hr x leakage factor, .'CFM Measured airflow method RyA3 Enter measured fan flow in CFM here _ x leakage factor = .CFM ": Enter value.forrActual leakage (CFM) in the right column, from measurement using applicable duct leakage Actual Leakage pressurization test procedure from Reference Residential Appendix RA3.1(CFM @ 25 Pa). (CFM) C List Actual Leakage from duct leakage test(CFM) 62 Pass if Actual Leakage is•le9s than Allowed Leakage ® Pass ❑ Fail For complete replacement of duct systems only, if the 6 percent leakage rate criteria cannot be met, a smoke test should be performed to verify that the excess leakage is coming only from a pre-existing furnace cabinet , (air handler cabinet), and not from otheraccessib/e portions of the duct system. A HERS rater must verify the installation (No sampling allowed). List Actual Leakage from smoke test(CFM) Pass if all accessible leaks (except for existing air handler) are sealed using smoke ❑ Pass ❑Fail Reg: 210-N0000632A-M2000028A-M20A Registration Date/Time: 2012/12/05 18:41:55 HERS Provider: Ca10ERTS, "r CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING - CF-411-MECH-20 Duct Leakage Test - Completely New or Replacement Duct System (Page 2 of 2) Site Address: 81-894 Seabiscuit Way, La Quinta CA 92253 (System Enforcement Agency: Permit Number: - 1) City of. La Quinta° 12-818 • it • 'f " I' 4r .. - ., y f' P® Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off during duct 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 a during duct leakage'testing. , r . ® All supply and return register boots must be sealed to the drywall ® New duct installations cannot util zl a buildingTcevltlesva's°+plenum"s or=Iplatform;returnslin~lieurof ducts'*-..' �V Mastic and.draw bands must be used .in combination with,Cloth backed„rubbeCadhesive duct1tape to seal'leaks at UCt conneCtlons.•'�*+----•+r....... .... ,,y,,; DECLARATIONATATEMENT • I certifOunder.penalty,of pequr`y�under,,( laws of, the Stat California, the informationfprovided on this form is true and correct • I am the certified HERS rater who performed the'verifieation 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 Certificates) (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 -6111) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) )BS Mechanical, Inc. Responsible Person's Name: _ CSLB License:, Kim Sico 1837985 HERS Provider Data Registry Information Sample Group # (if applicable): N/A❑ ® tested/verified dwelling not-tested/verified dwelling in ' ` a HERS sample group HERS Rater Information CalCERTS Certificate # CC1-1798706086 r HERS Rater Company Name: - . • a BCI Testing ' Responsible Rater's Name: Responsible Rater's Signature: } William Irvine William Irvine Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 12/4/2012 CC2004075 ` -+' t, •,�� 1. �� t •{� •.k .. .` r OF .Reg: 210-N0000632A-M2000028A-M20A,•Registration Date/Time:'-'2012/12/05 18:41:55 HERS Provider: Ca10ERTS, t Y CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R=MECH-20 Duct Leakage Test - Completely New or Replacement Duct System (Page 1 of 2) Site Address: 81-894 Seabiscuit Way, La Quinta CA 92253 (New Enforcement Agency: c Permit Number: System) City La Quints 1ermit , Enter the Duct System Name or Identification/Tag: New System Enter the Duct System Location or Area Served: living - Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the dwelling. This certificate is required for compliance for completely new duct systems installed in new dwelling construction, and also for completely new or replacement duct systems in existing dwellings. 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. i .Duct Leakage Diagnostic Test - completely new or replacement ducts stem Enter a value for the Allowed Leakage (CFM) for the duct system leakage verification. The value entered must be the VLLDCS criteria or one of the three calculated leakage rates described below. + Verified Low Leakage Ducts in Conditioned Space (VLLDCS) Compliance Credit. If compliance credit for Allowed verified low leakage ducts in conditioned space is shown in the special features section of the CF -1R, the Leakage leakage to outside test method must be used to verify duct leakage (refer to RA3.1.4.3.4), and 25 CFM must (CFM) be entered for Allowed Leakage. , Allowed leakage calculation - (select one calculation method from this section). Use 6% (leakage factor = 0.06) for calculations. When utilizing Low Leakage Air Handler (LLAH) credit, the allowed duct leakage may be specified by the CF -1R to be less than 6%, in which case the user-specified leakage rate must be used in the f. calculations below. For example, if the user-specified leakage (specified as a percentage of fan airflow) is reported on the CF, 1R'as 3%, thenluse a/eakage factor of 0.03 in the calculations below. 4, ® Cooling system method: _tNominal capacit of condenser in Tons,' 4 x -400 �,CFM z-/eaka g fa tor., ❑ Heating system method: �4 , 21.7 x ( Output Capacity in.Thousands of Btu/hr x /eaka factor CFM K A( 7-11- ❑ measured {airflow method (RA3.3) Enter measured fan flow in CFM'here "x leakage factor `. CFM r Enter value for.•Actual leakage (CFM) in the right column, from measurement using applicable duct Actual Leakage `leakage pressurization test procedure from Reference Residential Appendix RA3.1(CFM @ 25 Pa). (CFM) List Actual Leakage from duct leakage test(CFM) 71 Pass if Actual Leakage is -less than Allowed Leakage '® Pass ❑ Fail For complete replacement of duct systems only, if the 6 percent leakage rate criteria cannot be met, a smoke test should be performed to verify that the excess,leakage is coming only from a pre-existing furnace cabinet (air handler cabinet), and not from otheraccessib/e portions of the duct system. A HERS rater must verify the installation (No sampling allowed). . ' ' k ( ) Pass if all List Actual Leakage from smo a test CFM accessible leaks (except for existing air handler) are sealed using smoke ❑pass ❑Fail Y Y', A Reg: 210-N0000632A-M2000029A-M20A, Registration'Date/Time:,2012/12/05 18:41:55 HERS Provider: Ca10ERTS, 4 S, CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-20 Duct Leakage Test - Completely New or Replacement Duct System (Page 2 of 2) Site Address: 81-894 Seabiscuit Way, La Quinta CA 92253 (New Enforcement Agency: City of La Quinta Permit Number: 12-818 System) 1837985 HERS Provider Data Registry Information r t Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off during duct eakage 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. 11 ® All supply and return register boots must be sealed to the drywalls ® New duct installations cannot utilize,buiI'ding�c`avitiesya`sypleums nor-platfoYmiretuins:inYlieuTof;ducts: r l' 11 It' I dei'' + i f -sr ._. f, r: +�• �, f + 4 f, 1• Mastic and draw bands must be used in combination with Cloth backed; rubber, adhesive duct'tape to seal leaks at act connections. DECLARATIO NfSTATEMENT, a -, S • I certify under=penalty of perlury�,under,the laws ofahe State of,California, the informatioa�provided on this form,is'true and,.correct er •, • 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 -6R), signed and submitted by the person(s) responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -1R) approved by the enforcement agency. "\, Builder or Installer information as shown on the Installation Certificate (CF -611) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) JBS Mechanical, Inc. Responsible Person's Name: CSLB License: Kim Sico 1837985 HERS Provider Data Registry Information Sample Group # (if applicable): N/A FOtested/verified dwelling ❑ not-tested/verified dwelling in la HERS sample,group HERS Rater Information 'CaICERTS Certificate # CCl-1798706086 HERS Rater Company Name: BCI Testing Responsible Rater's Name: , . Responsible Rater's Signature: William Irvine William Irvine Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 12/4/2012. CC2004075 r r • CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF -4R -MEC Verification of High EER Equipment (Page 1 Site Address: Enforcement Agency: Permit Number: 81-894 Seabiscuit Way, La Quinta CA 92253 City of La Quinta 12-818 Verification of High EER Equipment Procedures for verification of High EER Equipment are described in Reference Residential Appendix RA3.4. For dwelling units W multiple systems, the procedures must be applied to each system separately. As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional form(s) for anv additional systems in the dwellina as aDDlical 1 System Name or Identification/Tag System 1 New System CSLB License: ° Kim Sico 2 System Location or Area Served bedrooms Living ❑ not-tested/verified dwelling 3 Certified EER Rating of the installed equipment (Btu/Watt-hr) 11.5 11.5 BCI Testing Responsible Rater's Name: 4 Make and Model Number of the installed Outdoor Unit BRYANT CARRIER Date Signed: 12/4/2012 CC2004075 CA13NA048 CA13NA048 5 Make and Model Number of the installed Inside Coil ALLSTYLE ALLSTYLE ASFM4826A28G ASFM4826A28G 6 Make and Model Number of.the installed Furnace or Air Handler. • CARRIER BRYANT 3103AV048070 3103AV048070 7 Minimum Equipment EER required for compliance as reported on the CF -1R 11.5 it ® When a high EER system specification includes a time delay relay, the installation of the time delay relay must be verified for compliance crec Refer to Reference Residential Appendix RA3.4.3 for the Time Delay Relay Verification Procedure. ® When installation of specific matched equipment is necessary to achieve a high EER, installation of the specific equipment must be verified fol compliance credit. Refer to Reference Residential Appendix RA3.4.3 for the Matched Equipment Verification Procedure. If the Certified EER Rating -in row 3 is equal to or greater than ' 8 the required minimum EER in row 7, the unit complies. PASS ' PASS If the unit complies enter Pass 7 IVY may' 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 instal complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified on the Certificat Compliance (CF -SR) 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 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) 3BS Mechanical, Inc. Responsible Person's Name: CSLB License: ° Kim Sico 1837985 HERS Provider Data Registry Information Sample Group # (if applicable): 'N/A ® tested/verified dwelling ❑ not-tested/verified dwelling HERS sample group' HERS Rater Information CalCERTS Certificate # CC1-1798706086 HERS Rater Company Name: BCI Testing Responsible Rater's Name: Responsible Rater's Signature: William Irvine William Irvine Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 12/4/2012 CC2004075 Reg: 210-N0000632A-M2300031B-M23A Registration Date_ /Time: 2012/12/05 18:57:05 HERS Provider: Ca10ERTS, r Reg: 210-N0000632A-M2300031B-M23A Registration Date_ /Time: 2012/12/05 18:57:05 HERS Provider: Ca10ERTS, 'ERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-23 ✓erification of High EER Equipment (Page 1 of 1; Site Address: Enforcement Agency:712-818 ermit Number: 81-894 Seabiscuit Way, La Quinta CA 92253 City of La Quinta , Verification of High EER Equipment Procedures for verification of High EER Equipment are described in Reference Residential Appendix RA3.4. For dwelling units with multiple systems, the procedures must be applied to each system separately. 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. ' 1 System Name or Identification/Tag System 1 New System CSLB License: Kim Sico 2 System Location or Area Served bedrooms Living ❑not-tested/verified dwelling in 3 Certified EER Rating of the installed equipment HERS Rater Information CaICERTS Certificate # CC1-1798706086 HERS Rater Company Name: + BCI Testing - Responsible Rater's Name: Responsible Rater's Signature: (Btu/Watt-hr) 11.5 11.5 Date Signed: 12/4/2012 ` CC2004075 4 Make and Model Number of the installed Outdoor Unit BRYANT CARRIER CA13NA048 CA13NA048 5 Make and Model Number of the installed Inside Coil ALLSTYLE ALLSTYLE ASFM4826A28G ASFM4826A28G 6 Make and Model Number of the installed Furnace or Air CARRIER - BRYANT Handler. 3103AV048070 3103AV048070 7 Minimum Equipment EER required for compliance as reported on the CF -1R 11.5 11 ® When a high EER system specification includes a time delay relay, the installation of the time delay relay must be verified for compliance credit. Refer to Reference Residential Appendix RA3.4.3 for the Time Delay Relay Verification Procedure. ® When installation of specific matched'equipment is necessary to achieve a high EER, installation of the specific equipment must be verified for compliance credit. Refer to Reference Residential Appendix RA3.4.3 for the Matched Equipment Verification Procedure. If the Certified EER Rating in row 3 is equal to or greater 8 than.the required minimum EER in row 7, the unit complies. PASS PASS - M ' If the unit complies enter Pass V --- DECLARATION STATEMENT ` • I certify under penalty of perjury, ider 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 -6111) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) JBS Mechanical, Inc. Responsible Person's Name: CSLB License: Kim Sico 1837985 ' HERS Provider Data Registry Information Sample Group # (if applicable): N/A ®tested/verified dwelling ❑not-tested/verified dwelling in a HERS sample group HERS Rater Information CaICERTS Certificate # CC1-1798706086 HERS Rater Company Name: + BCI Testing - Responsible Rater's Name: Responsible Rater's Signature: William Irvine William Irvine Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 12/4/2012 ` CC2004075 d Reg: 210-N0000632A-M2300031B-M23A Registration Date/Time: 2012/12/05 18:57:05 HERS Provider: Ca10ERTS, n CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-25 Refrigerant Charge Verification -,Standard Measurement Procedure (Page 1 of 5) Site Address: Enforcement Agency: Permit Number: 81-894 Seabiscuit Way, La Quinta CA 92253 .7City of La Qu 1 12-818 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 SuoDly and Return Plenums of Air Handler System Name or Identification/Tag System 1 _ New System System Location or Area Served living I Living 1 ® Yes ❑ No v 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 land -2 is a pass. t Enter Pass or Fail ' ✓ ® Pass ✓ ❑ Fail . STMS = Sensor,_on,;the�Evaporator Coil.,,�„�,,� System Name"or Identification/Tag System 1 ,"" W.N 3 Yes p No The sensor is factory installed, or field installed according to manufacturer's______ specifications, or is installed by myeth6ds/specifications approved by the Executiv; ❑ Yes ❑ No ' Director. "i, .:�..�«r.►�i. /�• / .: II A. � �r'y: �h- �M 4 �,'� •, p,Yes 1, } j4 No The sensor wire is terminattedmithia-standard mini;plug suitable for connection ta , o digital,thermorn ter:,The`senso`r.mini plug is to the installing technician ❑ Yes ❑ No ..`gip accessible and tfie'HERS``rat6F without changing,the'airflow thr66gh the'condenser coil 5 + ❑ Yes-- ❑ No When attached to a digital thermometer, the sensor provides an indication of the ❑ Yes , -r— - \1 saturation temperature of the coil. Yes to 3, 4, and 5 is a pass. Enter N/A if STMS are not applicable. Otherwise enter Pass or Fail ✓ ®N/A ✓ ❑Pass ✓ ❑Fail STMS - Sensor on the Condenser Coil System Name or Identification/Tag I System 1 New System - , 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 V ® N/A ✓ ❑ Pass ✓ ❑ Fail applicable. Otherwise enter Pass or Fail Reg:'210-N0000632A-M2500037A-M25A Registration Date/Time: 2012/12/06 17:03:35 HERS Provider: Ca10ERTS, V + New System Date of ThermocoupledCalibration *`�! ii f '�,f... _.. . 12/5/2012 i�j�� System Location or Area Served Living .. Living Outdoor Unit Serial # 4312X74780 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-25 Refrigerant Charge Verification— Standard Measurement Procedure (Page 2 of 5) Site Address: I Enforcement Agency: Permit Number: , 81-894 Seabiscuit Way, La Quinta CA`92253 . City of La Quinta 12-818 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 Svstems ' System Name or Identification/Tag System 1 New System Date of ThermocoupledCalibration *`�! ii f '�,f... _.. . 12/5/2012 i�j�� System Location or Area Served Living .. Living Outdoor Unit Serial # 4312X74780 4312X74768 -+-r•+:-----•� Outdoor Unit Make CARRIER CARRIER ,ate ,r +rr �r,- *vF �'a Outdoor Unit Model CA13NA048 f CA13NA048 Nominal Cooling Capacity Btu/hr l r 48000 48000 _ Date of Verification '' 12/6/2012 .12/6/2012 temperature (Treturn, wb) . K`+. i r 4 %.d11Dr4L1U" Vr U1agn05[I1; inbirumenrs Date of Refrigerant Gauge Calibration 12/5/2012 (must be re -calibrated monthly) Date of ThermocoupledCalibration *`�! ii f '�,f... _.. . 12/5/2012 i�j�� .-�l" (must be re -calibrated monthly) ; measurea iemperazures-(,,r) ;11, i System Name or Identificat oriR g p g� • Syst em 1 New System•Y- Supply'(evaporator leaving) _air drybulb'!, r _-,TT' -+-r•+:-----•� -- -aE- � --•�--' ,ate ,r +rr �r,- *vF �'a i System Name or Identificat oriR g p g� • Syst Supply'(evaporator leaving) _air drybulb'!, r _-,TT' temperature'(Tsupply, db) i F r ;„ Return (evaporator entering) air dry-bulb temperature (Treturn, db) } Return (evaporator entering) air wet -bulb c - temperature (Treturn, wb) . K`+. i r 4 Evaporator saturation temperature • ' 35 33 (Tevaporator, sat) . , Condensor saturation temperature 93 + • a91 (Tcondensor, sat) Suction line temperature (Tsuction) 39 `;41 ". Liquid Line Temperature (Tliquid) 85 t, 83 4 •. Condenser (entering) air dry-bulb T-8-0 81 1 temperature (Tcondenser, db) 1 , Reg: 210-N0000632A-M2500037A-M25A Registration Date/Time:'2012/12/06 17:'03:35 HERS Provider: Ca10ERTS, • �• a �-..k ... � � �, � • ' � . .. • �'' . , -' - � . J INSTALLATION CERTIFICATE CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5) Site Address: Enforcement Agency: Permit Number: 81-894 Seabiscuit Way, La Quinta CA 92253 1 City of La Quinta 12-818 7- 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 ' F + -100°F Enter Pass or Fail n. 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 (dm/ton) t _ L_ _ System, �me o Id ntification/Tag System 14r NeSystem M v d - .;•� a�t..;V r r Calculated, Minimum Airflow Requirement (CFM) 1 �200 .�j1200 •---- � +F ' �J`' • ri' �' '/ f. H t , _... Measure8,Airflow usmg1RA3 3 procedures 13 77 k� 1321-^ (CFM) em* Passes if measured airflow is greater than or `. equal to the calculated minimum airflow requirement— . �� j PASS PASS ` , Enter. Pass or Fail 1� ] Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for fixed orifice metering device systems System Name or Identification/Tag Calculate: Actual Superheat = ' Tsuction - Tevaporator, sat Target Superheat from Table RA3.2-2 using Treturn, wb and Tcondenser, db Calculate difference: " Actual Superheat - Target Superheat System passes if difference is between -6°F and +6°F ' F + ! Enter Pass or Fail Reg: 210-N0000632A-M2500037A-M25A Registration Date/Time:,2012/12/06 17:03:35 HERS Provider: Ca10ERTS, INSTALLATION CERTIFICATE CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5) Site Address: I . Enforcement Agency: Permit Number: 81-894 Seabiscuit Way, La Quinta CA 92253 City of La.Quinta 12-818 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 New System Calculate: Actual Subcooling = g,0 8.0 Tcondenser, sat - Tliquid 4.0 - 8.0 Target Subcooling specified by manufacturer 10 10 Calculate difference: :2 -2 Actual Subcooling -'Target Subcooling = 3 to 26 ! 3 to 26 System passes if difference is between - -4°F and +4°F PASS j 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', ti New System Calculate: Actual Superheat = 4.0 - 8.0 Tsuction - Tevaporator, sat ` Enter allowable superheat range from man 6facturer's-specifications (or use range 3 to 26 ! 3 to 26 between 3°F and 26°F if manufactu'rer's specification is not available) System asses°if actual superheat is within the`v+fy'fr'r ' alk owable superheat range /`, f�+',; '� PASS s. PASS, �•4,".=a, r �,. ,� � „s.i,�4p: , �• i"'�?�= ,� r' "",�----;.� o� �rEiiterjPass or Fail s 4 � s. r n u , r r Reg: 2107N0000632A-M2500037A-M25A Registration Date/Time: 2012/12/06,17':03:35 HERS Provider; Ca10ERTS, r INSTALLATION CERTIFICATE CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5) Site Address: Enforcement Agency: Permit Number - 81 -894 Seabiscuit Way, La Quinta CA 92253 City of La Quinta 12-818 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 New System HERS Provider Data Registry Information ` System meets all refrigerant charge and ❑ not-tested/verified dwelling in la HERS sample group airflow requirements. PASS PASS Responsible Rater's Name: Responsible Rater's Signature: , ' Enter Pass or Fail ' ' Date Signed: 12/6/2012 • , r a tl ' -I'. %°r fj I`t e �'..-f ri. -••ak ti "r• -.F",:. C*�DECLARATION STATEMENT • I certify under penalty of perjury, u Eder the laws of the State of California, the information provided on this form is true and correct. • I am the certified HERS rater who performed the verification services identified and reported on this certificate (responsible rater), • • The installed feature, material, component, or manufactured device requiring HERS verification that is identified on this certificate (the installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified on the Certificate(s) of Compliance (CF -1R) approved by the local enforcement agency. • The information reported on applicable sections of the Installation Certificate(s) (CF -6R), signed and submitted by the person(s) responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -1R) approved by the enforcement agency. ` . Builder or Installer information as shown on the Installation Certificate (CF -611) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) 7BS Mechanical, Inc. Responsible Person's Name: CSLB License: Kim Sico 1837985 HERS Provider Data Registry Information Sample Group # (if applicable): N/A ® tested/verified dwelling ❑ not-tested/verified dwelling in la HERS sample group HERS Rater Information Ca10ERTS Certificate # CC1-1798706086 HERS Rater Company Name: , BCI Testing Responsible Rater's Name: Responsible Rater's Signature: , William Irvine William Irvine Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 12/6/2012 • , CC2004075 - Reg: 210-N0000632A-M2500037A-M25A ;Registration Date/Time:.2012/12/06j17:03:35 HERS Provider:•Ca10ERTS, I CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure � (Page 1 of 5) Site Address: Enforcement Agency: Permit Number: 81-894 Seabiscuit Way, La Quinta CA 92253 1 City of La Quinta 1 12-818 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. r s As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional form(s) for any additional systems in the dwelling as applicable. Temperature Measurement Access Holes (TMAH) and Saturation Temperature Measurement Sensors (STMS) Procedures for installing TMAH are specified in Reference Residential Appendix RA3.2. `If refrigerant charge verification is required for compliance, TMAH are also required for compliance. STMS are only required for completely new or + replacement space -conditioning systems that utilize prescriptive compliance method. . TMAH - Access Holes in Supply and Return Plenums of Air Handler _ System Name or Identification/Tag System 1 New System System Location or Area Served living Living 1 ® Yes ❑ No ' 5/16 inch (8 mm) access hole upstream of evaporative coil in the return plenum and labeled according to Figure in Section RA3.2.2.2.2. 2 ® Yes ❑ No 5/16 inch (8 mm) access hole downstream of evaporative coil in the supply plenum and labeled according to Figure in Section RA3.2.2.2.2. Yes to'l.and 2 is a pass. (• Enter Pass or Faill ✓ ® Pass ✓ ❑ Fail . + STMS - Sensor.onythe. Evaporator Coil System Name°or Identification/Tag'] '. `/ .' .System 1 .--t ;-New:Systern -', 3 ❑ Yes o„. E N ' : The sensor is factory installed, or field installed according to manufacturer's specifications, or isoinstalled by methods/specifications approved by the Executive'; ❑ Yes ❑ No jT' / Director. • ;,K �.. ��#h. • k'. _�.-. .. +—' ,..w 4 ElXes r No The sensor wire is term inated,with a-standardmini,plug suitable for, connection �to a .” digital;the'ometer:;The-sensor plug to the installing 10 ?and mini rm"is accessible technician tH6 HERS iater without changing the airflow through the condenser coil"' 5 r' prYes.. , '❑ No 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 applicable. Otherwise enter Pass or Fail ® N/A " ✓ ❑ Pass ✓ ❑ Fail STMS - Sensor on the Condenser Coil System Name or Identification/Tag I System 1 1 New System The sensor is factory installed, or field installed according to manufacturer's 6 ❑ Yes ❑ No specifications, or is installed by methods/specifications approved by the Executive Director. The sensor wire is terminated with a standard mini plug suitable for connection to a 7 ❑ Yes ❑ No digital thermometer. The sensor mini plug is accessible to the installing technician and the HERS rater without changing the airflow through the condenser coil . 8 ❑ Yes ❑ No When attached to a digital thermometer, the sensor provides an indication of the saturation temperature of the coil. Yes to 6, 7, and 8 is a pass. Enter N/A if STMS are not ✓ ®N/A ✓ [3 Pass ✓ El Fail applicable. Otherwise enter Pass or Fail Reg: 210-N0000632A-M2500037A-M25A Registration Date/Time:,2012/12/06 17:03:35 HERS Provider: Ca10ERTS, 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:, 81-894 Seabiscuit Way, La Quinta CA 92253 City of La Quinta 12-818 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 rocedure.: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 Svstems System Name or Identification/Tag System 1 'New System Date of Thermocouple, Calibration r { 12/5%2012 System Location or Area Served Living Living F Outdoor Unit Serial # 4312X74780 4312X74768- 312X74768-Outdoor OutdoorUnit Make CARRIER. CARRIER Outdoor, Unit Model CA13NA048 CA13NA048 Nominal Cooling Capacity Btu/ hr 4 48000 + 48000 - Date of Verification 12/6/2012 12/6/2012 Calibration of Diagnostic Instruments Date of Refrigerant Gauge Calibration 12/5/2012 - (must be re-calibrated.monthly) Date of Thermocouple, Calibration r { 12/5%2012 (must be re -calibrated monthly) Measured Temperatures`+(, F) . �._. System Name or Identification/Tag;Systema New System---,..-�'� r 1_= ,` temperature (TsuPPIY, db) ��' , temperature (Treturn, db) " Reg: 210-N0000632A-M2500037A-M25A Registration Date/Time:-2012/12/06 17:03:35 HERS Provider: Ca10ERTS, • , Supply (evaporator,leaving),air dry-bulb." r 1_= ;..d temperature (TsuPPIY, db) Return (evaporator entering) air dry-bulb , temperature (Treturn, db) " Return (evaporator entering) air wet -bulb temperature (Treturn, wb) Evaporator saturation temperature - 35 33 (Tevaporator, sat) Condensor saturation temperature 93 91 (Tcondensor, sat) Suction line temperature (Tsuction) 39 41 " Liquid Line Temperature (Tliquid) 85 83 , Condenser (entering) air dry-bulb 80 81 temperature (Tcondenser, db). ' Reg: 210-N0000632A-M2500037A-M25A Registration Date/Time:-2012/12/06 17:03:35 HERS Provider: Ca10ERTS, • , INSTALLATION CERTIFICATE CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5) Site Address: Enforcement Agency: TPiermit Number: '81-894 Seabiscuit Way, La Quinta CA 92253 City of La Quinta 818 , Minimum Airflow Requirement r • ' Temperature Split Method Calculations for determining Minimum Airflow Requirement for Refrigerant Charge • Verification. The temperature split method is specified in Reference Residential Appendix RA3.2. System Name or Identification/Tag Calculate: Actual Temperature Split = Treturn, , Y 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 V• . 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 Naor Name Identification/Tag r r System 1'z" New System -. Calculated Minimum Airflow Requirement (CFM) 1200 i t X1200 , -- i Measured,Airflow.using RA3'3 procedur`es 4-... 1377" ' 1321;` � x� �- (CFM)` "°.�7"°""� .°".zz`r.„ �T� _ Passes if measured airflow is greater than or_ - ,' • �^a equal to the calculated minimum airflow requirement. . ' `t I PASS .+�, PASS u , -t,, 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: 210-N0000632A-M2500037A-M25A Registration Date/Time: 2012/12/06 17:03:35, HERS Provider: Ca10ERTS, z INSTALLATION CERTIFICATE CF-4R-MECH725 Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5) Site Address: Enforcement Agency: Permit Number: 81-894 Seabiscuit Way, -La Quinta CA 92253 City of La Quinta 12-818 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• New System M Calculate: Actual Subcooling = 8.0 8.0 Tcondenser, sat - Tliquid Target Subcooling specified by manufacturer 10 10 Calculate difference: 3 to 26 -2 ' Actual Subcooling - Target Subcooling = -2 System passes if difference is between -4°F and +4°F r t PASS PASS Enter Pass or Fail f, t ; ,' ( ` •' '' -,.- ..�.�,, Metering Device Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag A System 1 .'New System M Calculate: Actual Superheat = 4.0 "S.0 Tsuction -. Tevaporator, sat Enter allowable superheat range from , manufacturer's specifications (or use range 3 to 26 t 3 to 26 ' between 3°F and 26°F if manufacturer's specification is not available)..:__,, System passes>if actual superheat isywithiwthe' allowable superheat range PASS PASS pass or Fail f, t ; ,' ( ` •' '' -,.- ..�.�,, ,0,�Eftter �.. �'..^ sYP. 'i!-.y=.Sr'e,..-! ..!•.,�.� -fa•., s .: �'. 'i I-'r;:t! ?n,��' ' err - • - • T 1. I ' t •3 '?• Arm � ' °� ... -`' � ' Reg: 210-N0000632A-M2500037A-M25A Registration Date/Time: 2012/12/06 17:03:35 HERS Provider: Ca10ERTS, r e INSTALLATION CERTIFICATE CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5) Site Address: I Enforcement Agency: Permit Number: 81-894 Seabiscuit Way, La Quinta CA 92253 City of, La Quinta 12-818 0 Standard Charge Measurement Summary: .J ' 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 New System HERS Provider Data Registry Information Sample Group # (if applicable): N/A ® tested/verified dwelling ❑ not-tested/verified dwelling in a HERS sample group System meets all refrigerant charge and HERS Rater Company Name: a ,, BCI Testing �. ,,, •,:�• r ' Responsible Rater's Name: Responsible Rater's Signature: airflow requirements. . PASS_. PASS Date Signed: 12/6/2012 CC2004075 Ent _ er Pass or Fail ti ' "•. .. •� ' •ter....- r � •. .. - � ,`,h.L;�-.•-.q. I r ...,r«- .o.. ai s.� wr •-i�.. 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 -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 -111) approved by the enforcement aoencv. ` - - Builder or Installer information as shown on the Installation Certificate (CF -6R) Company, Name: (Installing Subcontractor or General Contractor or Builder/Owner); , JBS Mechanical, Inc. r.1 .1' Responsible Person's Name:CSLB License: Kim Sico 837985 HERS Provider Data Registry Information Sample Group # (if applicable): N/A ® tested/verified dwelling ❑ not-tested/verified dwelling in a HERS sample group HERS Rater Information Ca10ERTS Certificate # CC1-1798706086 HERS Rater Company Name: a ,, BCI Testing �. ,,, •,:�• r ' Responsible Rater's Name: Responsible Rater's Signature: _ William Irvine William Irvine' Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 12/6/2012 CC2004075 Reg: 210-N0000632A-M2500037A-M25A Registration Date/Time:•2012/12/06 17:03:35HERS Provider: Ca10ERTS,