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12-0803 (MECH)c&t�/ 4 4 Q" BUILDING & SAFETY'DEPARTMENT BUILDING PERMIT Owner: BRUMMEL EDWARD 51285 CALLE PALOMA LA QUINTA, CA 92253 Contractor: VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 7/19/12 Applicant: Architect or Engineer: HYDES I r 3 42949 MAD20 STREET U II 16 2 2012 , INDIO, CA 92.201 JUL: (760)3610-2202 Lic: Nc.: 906115 CITY OF FINAMCE:DEPT LICENSED CONTRACTOR'S DECLARATION" WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty ofperjury•that I amiicensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of.perjur' oneof� the following declarations: Section 7000) of Division 3 of &'Business and Professi ` al'C ode, and my License is in full force and effect;. have and ,:will maintain a.certificate of.consent to self -insure for workers' compensation, as provided License Class: C20 C36 License No.: 9.06115 .for by�Seclion 3700 of the Labor Code, for the performance of the work forwhich this permit is issued .. Date: •� "' •!- S' ontracton"', • ' I have and will%maintain workers' compensationansurance;as required by Section 3700 of the Labor' /_ Code, for the -,.performance of the -,work for. which this permit is. issued •..My workers'compensaiion OWNER-BUILDEW DECLARATION - . insurance carrier and policy numbar are:t . '" - "• - I hereby affirm under' penalty. of perjury that Pam exempt from the &riiractor's State License Law for the Carrier NORGUARD' INS, Policy Number CEWC243358 following reason,(Sec. 7031".5, Business and Professions Code:' Any city o'vcountyAat requires a permitAo _ I certify that,'in the performance of the work for which this permit is issued, I shall not employ any construct; alter, improve, demolish,.or repair any structure, prior its issuance, also requires the applicant for the person in any manner so as to become subject to the workers' compensation Iaws'of California, permit to file a signed statement that he or she is licensed pursuant to the provisions"I of the Contractor's State - and agree that; if I should become subject to the workers' compensation provisions of Section License Law (Chapter 9 (commencing with Section.7000).of Division 3 of,the'Business-and Professions Code) or 3700 of the Labor Code, I'shall for Ai co with tho visions. that he or she is exempt therefrom and the basis for the alleged exemption. - Any violation of Section7031.5 by any applicant for a permit subjects the applicant -to acivil penalty of not more than five hundred dollars ($500)": ate: plicant: (. ) I, as owner of the property, or my employees with wages as their sole compensation, will do the work,.and � r - the struct0re is not intended of offered for sale (Sec. 7044; Business and,Pr`ofessions Code: :Ttie WARNING: FAILURE•TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL - Contractors' State License Law does'not apply to an owner of property who builds or.improves thereon, SUBJECT -AN -EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND _ "and who does.the work himself or herself through his or her own employees, provided that the DOLLARS ($100,000)• IN ADDITION To THE C6ST.OF COMPENSATION,,DAMA(3ES•AS PROVIDED FOR IN improvements are,not intended or offered for sale. If, however, the building or improvement is sold within , SECTION 3706 OF THE LABOR CODE, INTEREST`AND ATTORNEY'S FEES.. one year of completion, the owner-builderwill, have the burden of provingthat he or she did not build,_or improve for the purposeof sale.). "+ - APPLICANT ACKNOWLEDGEMENT " 1 _ 1 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application. - property who -builds or improves thereon, and who contracts for the projects with a contractor(s) licensed 1 . Each person upon,whose behalf this.application is made, each "person at whose request and for ' pursuant to the Contractors' State License Law.). whose benefit work id performed under or.pursuant-to any permit issued as a result of this application, I—) "I am exempt under Sec. BAP.C. for this reason 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 Date: - Owner: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there'is a construction lending agency for the performance of the work for which this permit is issued ISec. 3097, Civ. C.). Lender's. Name: Lender's Address PR LQPERMIT performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit; or cessation of work for 180 days will subject permitto cancellation. j 1 certify that I have read this application and state that the above information is correct. I afire/t6 comply with all city and county ordinances and state laws relating to building construction, and hereby autho ze representatives of this county to entery on the above-mentioned property for inspection rposes. Oate: / nature (Applicant.or Agent): JV P.O. BOX 1504 78-495 CALLE TAMPICO- LA QUINTA, CALIFORNIA 92253 Application Number: 12=0000080 Property Address: 51285 CALLE PALOMA APN: 770-142-008-97 -000000- Application description: 'MECHANICAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 5600 c&t�/ 4 4 Q" BUILDING & SAFETY'DEPARTMENT BUILDING PERMIT Owner: BRUMMEL EDWARD 51285 CALLE PALOMA LA QUINTA, CA 92253 Contractor: VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 7/19/12 Applicant: Architect or Engineer: HYDES I r 3 42949 MAD20 STREET U II 16 2 2012 , INDIO, CA 92.201 JUL: (760)3610-2202 Lic: Nc.: 906115 CITY OF FINAMCE:DEPT LICENSED CONTRACTOR'S DECLARATION" WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty ofperjury•that I amiicensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of.perjur' oneof� the following declarations: Section 7000) of Division 3 of &'Business and Professi ` al'C ode, and my License is in full force and effect;. have and ,:will maintain a.certificate of.consent to self -insure for workers' compensation, as provided License Class: C20 C36 License No.: 9.06115 .for by�Seclion 3700 of the Labor Code, for the performance of the work forwhich this permit is issued .. Date: •� "' •!- S' ontracton"', • ' I have and will%maintain workers' compensationansurance;as required by Section 3700 of the Labor' /_ Code, for the -,.performance of the -,work for. which this permit is. issued •..My workers'compensaiion OWNER-BUILDEW DECLARATION - . insurance carrier and policy numbar are:t . '" - "• - I hereby affirm under' penalty. of perjury that Pam exempt from the &riiractor's State License Law for the Carrier NORGUARD' INS, Policy Number CEWC243358 following reason,(Sec. 7031".5, Business and Professions Code:' Any city o'vcountyAat requires a permitAo _ I certify that,'in the performance of the work for which this permit is issued, I shall not employ any construct; alter, improve, demolish,.or repair any structure, prior its issuance, also requires the applicant for the person in any manner so as to become subject to the workers' compensation Iaws'of California, permit to file a signed statement that he or she is licensed pursuant to the provisions"I of the Contractor's State - and agree that; if I should become subject to the workers' compensation provisions of Section License Law (Chapter 9 (commencing with Section.7000).of Division 3 of,the'Business-and Professions Code) or 3700 of the Labor Code, I'shall for Ai co with tho visions. that he or she is exempt therefrom and the basis for the alleged exemption. - Any violation of Section7031.5 by any applicant for a permit subjects the applicant -to acivil penalty of not more than five hundred dollars ($500)": ate: plicant: (. ) I, as owner of the property, or my employees with wages as their sole compensation, will do the work,.and � r - the struct0re is not intended of offered for sale (Sec. 7044; Business and,Pr`ofessions Code: :Ttie WARNING: FAILURE•TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL - Contractors' State License Law does'not apply to an owner of property who builds or.improves thereon, SUBJECT -AN -EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND _ "and who does.the work himself or herself through his or her own employees, provided that the DOLLARS ($100,000)• IN ADDITION To THE C6ST.OF COMPENSATION,,DAMA(3ES•AS PROVIDED FOR IN improvements are,not intended or offered for sale. If, however, the building or improvement is sold within , SECTION 3706 OF THE LABOR CODE, INTEREST`AND ATTORNEY'S FEES.. one year of completion, the owner-builderwill, have the burden of provingthat he or she did not build,_or improve for the purposeof sale.). "+ - APPLICANT ACKNOWLEDGEMENT " 1 _ 1 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application. - property who -builds or improves thereon, and who contracts for the projects with a contractor(s) licensed 1 . Each person upon,whose behalf this.application is made, each "person at whose request and for ' pursuant to the Contractors' State License Law.). whose benefit work id performed under or.pursuant-to any permit issued as a result of this application, I—) "I am exempt under Sec. BAP.C. for this reason 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 Date: - Owner: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there'is a construction lending agency for the performance of the work for which this permit is issued ISec. 3097, Civ. C.). Lender's. Name: Lender's Address PR LQPERMIT performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit; or cessation of work for 180 days will subject permitto cancellation. j 1 certify that I have read this application and state that the above information is correct. I afire/t6 comply with all city and county ordinances and state laws relating to building construction, and hereby autho ze representatives of this county to entery on the above-mentioned property for inspection rposes. Oate: / nature (Applicant.or Agent): JV Application Number . . . . . 12-00000803 Permit . . . MECHANICAL Additional desc . Permit Fee . . . . 40.50 Plan Check Fee 10.13 Issue Date . . . . Valuation . . 0 Expiration Date 1/15/13 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 9.0000 EA MECH FURNACE <=100K 9.00 1.00 16.5000 EA MECH B/C >3-15HP/>100K-500KBTU .16.50 -=--------------------------------------------- Special Notes and Comments ----------------------------- HVAC CHANGE -OUT: FURNACE, CONDENSER, INDOOR COIL. 2010 CODES. ---------------------------------------------------------------- Other Fees . . . . . . BLDG STDS ADMIN (SB1473) ------------ 1.00 Fee summary Charged Paid Credited ----------- Due .Permit-Fee Total 40.50 .00 .00 40.50 Plan Check Total 10.13 .00 .00 10.13 Other Fee Total 1.00 .00 .00. 1.00 Grand Total 51.63 .00 .00 51.63 LQPERMIT Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-iR-ALT-HVAC Climate Zones 10 - 15 Site Address: Enforcement Agency: Date: Permit #: 51-285 Calle Paloma La Quinta, CA 92253 City of La Quinta Jul 18, 2012 Duct insulation Conditioned Floor Equipment Typel List Minimum Efficiency2 requirement Area Thermostat ❑ Package Unit p Furnace © AFUE 78% ❑ COP ❑ R 6 (CZ 10-13) Served by system [21 Setback p Indoor Coil p SEER 13.0 ❑ HSPF ❑ R 8 (CZ 14-15) 1400 sf If not already present, must be [0 Condensing Unit ❑ EER p Resistance installed) ❑ Other 1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF-IR-ALT-HVAC for each system. 2. Minimum Equipment Efficiencies: 13 SEER, 78% AFUE, 7.7HSPF for typical residential systems. HERS VERIFICATION SUMMARY Listed below are FOUR HVAC alteration Options. The installer decides what work is being done and picks one of the appropriate Options. Each Option lists the HERS measures that must be conducted. A copy of the forms shall be left on site for final inspection and a copy given to the homeowner. At final, the inspector verifies that the work listed on this form was in fact the work completed by the installer. The inspector also verifies that each appropriate CF-6R and registered CF-4R forms (no hand filled CF-4Rs allowed) are filled out and sig ned.Beginning October 1, 2010, a registered copy of the CF-1111 and CF-611 shall also be on site for final inspection. D 1. HVAC Changeout Required Forms: . All HVAC Equipment CF-6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS replaced CF-4R forms: MECH-21 and (for split systems) MECH-25 . Condenser Coil and /or . Indoor Coil and /or CF-6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS . Furnace CF-4R forms: MECH-21 and (for split systems) MECH-25 For Split Systems: Duct leakaggk.15 percent; RC, CCA _< 300 CFM/ton (Minimum Air Flow Requirement), TMAH Exempted from duct leakage testing if: . ❑ 1."Duct system was documented-.to have been previously sealed and confirmed through HERS verification, or ❑ 2. Duct systems with lesshan�40.linear feet in unconditioned space, or [].3. Existing duct systems are constructed, insulated or sealed with asbestos ❑ 4. The�systern,wil) not beDucted (ie Ductless Mini-SplitFSystem) (AlsovExempt from Refrigemant Charge) ❑ 2. New HVAC,System Required Forms -.d� ff ,� �• � . Cut ins or Changeout with" ducts: CF 6R forms .MECH 09, MECH.20 HERS,and (for split systems) MECH-22 HERS and new (all new J.MECH ducting and all new k25-HERS' CF 4R forms MECH 20and tems). MECH=32, ME CH equipment) (for split sy and .25 For Split Systems 'Duct leakage <6 percent, RC,- CCA 5-,350CFM%ton, FWD TMAH, STMS, and either HSPP or`PSPP. uwp For Packaged Units: `Duct;leakage� < 6 percent *, `' ❑ 3, New-Ducts with/or without Required Forms: Replacement . Includes replacing or installing 'all new' ducting and/or outdoor condensing-unit' CF-611 forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS and/or indoor coil and/or furriac'e'No or some CF-4R forms: MECH-20 and (for split systems) MECH-25 equipment changed. For Split Systems: Duct leakage < 6,percent; RC, CCA 5-_ 300 CFM/ton, TMAH For Packaged Units: Duct leakage < 6 percent ❑ 4. New Ducting over 40 feet Required Forms: . Includes adding or replacing more than 40 CF-611 forms: MECH-04, MECH-2I-HERS linear feet of duct in unconditioned space. CF-4R forms: MECH-21 For split system or packaged units: Duct leakage < 15 percent ❑ EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos. Contractor (Documentation Author's /Responsible Designer's Declaration Statement) . I certify that this Certificate of Compliance documentation is accurate and complete. . I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of Compliance. . I certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24, Parts 1 and 6 of the California Code of Regulations. . The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with the permit application. Name: Mark Hyde Signature: Mark Hyde Company: CERTIFIED COMFORT SYSTEMS INC Date: Jul 18, 2012 Address: 42-949 MADIO STREET License: 906115 City/State/Zip: INDIO / CA / 92201 Phone: (760) 360-2202 Reg: 212-A0038163A-00000000-0000 Registration Date/Time: 2012/07/18 13:33:55 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms July 2010 Bin # Permit .# O Project Address: Woon: •r r �'�(E=phone: 6 C7 — •ZZ � Z ia`te Lic. # q 06- Cit} Arch., Engr., Designer: Address: City, ST, Zip: Telephone: City of Li 'Qumta Building & Safety Division P:O: Box' 1504; 78 495:.Calle Tampico La Quints; CA 92253 -.(760) 777-7012 Building Permit: Application and, Tracking Sheet K. Owner's Name: City, ST, Zip: 4 Q C 5t�n S A• /c Telephone: -� — • .U� Project Description: Lic. #:'-I � Z G �E%— t 53 _....__... .. Total Permit Fees + .;Construction Type: Occupancy: p cy: State Lie. #: Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person:11 11 Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: Estimated Value of Project: � 07 APPLICANT: DO NOT WRITE.BELOW THIS LINE # Submittal Req'd Recd_ TRACKING Plan Sets PERMIT FEES Plan Check submitted Structural Calcs. Reviewed, ready for corrections Item Amount Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Energy Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading. plan' god Review, ready for correciionsrassue Electrical Subcontactor List Called Contact Person Plumbing, Grant Deed Plans picked up S.M.I. H:OAL Approval Plans resubmitted Grading IN HOUSE:- 3"Review, for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.LP.P. Pub. Wks. Appr Date of permit issue School Fees _....__... .. Total Permit Fees CE.RTIFICATEW FIELD VERIFICATION &.DIAGNOSTICTESTING' CF 4R MECH-21 Duct Leakage Test Existmg'Duct System 5 ', .. .. ...:. .. . ... ... ,. _..k...�_._:. f ,(Page'1' of 2) .. .. Site Address..."' 51-285 Calle Paloma, La..Qulnta CA 92253 (System l) EnforcemehVAgency City:,of La,Quinta Pdr'mit Nuniber: 12-803; . Enter. the Duct,System Name or Identification/Tag: Systema Enter the Duct System. Location or Area Served-.. Whole'Hoiuse Note:' Submit one Installation Certificate for each duct system that fiiust demonstrate conipHance in the dwelling.- This installation certificate is required for compliance for alterations and additions in existing dwellings i space conditioning systems and duct systems. 1 Note: For existing dwellings, a completely.new or replacement duct systern.•can, also include' existing parts of the original duct system (e.g., register boots, air hand)er, coil, plenums, etc.) if those pacts';are accessible and they can be sealed. For a completely new or replacement ductsystem installed in an` existing dwelling, use the Installation Certificate titled "Duct Leakage, Test Col ipletely`'New or Replacement Duct System. " Duct Leakage Diagnostic Test'- exis6ng,,duct system Select one compliance method from the following four choices. ❑ 1. Measured leakage less than 15% of fan flow . ❑ 2. Measured leakage to outside�less:than 10% of Fan Flow ❑ 3. Reduce leakage by 6:0%!,a, co duct smoke and fix all leaks ❑ 4 Fix a., Sc s ble leaks using4 moke and HERS rater verify Note :(One of Options 1, 2; or 3 mube attempted before utilizing Option 4.). ; ._, _ Deterinrne nommatFan Flow using oneof the following three calculation methods ❑ Coolingstemm etfhod Size of d risen ns . x 40 CFM �' x ❑ Heating system method �1�7 xOutput Cap ca ity in Thonds of Btu/hr CFM xr x ❑ Measured system airflo w usn RA3 3 airflow te-CFM Optron iused�then}` Allowedxleakage Fan,Flow x 0 1 ii DEN , �r ActuarLeakage C CFM , } .. L .: , Pass rf Leakage Actual rs less than Allowed Pass Fail : Optron2;used then I*" Allowed _leakage Fan, Flow's xW0-10 = _ CFM Actual Lea.ka,g i to outside +��CFM .M i MAE.R Pass if Leakage Actual is Tess than Allowed b Pass Fail Option 3 used then Y Initial leakage to ofwork = CFM prior start _ Final leakage after sealing all accessible leaks using smoke test= CFM 3 Initial leakage _ - Final leakage _"' = Leakage reduction CFM ((Leakage reduction Initial leakage _) x 100% _' -9/o Reduction Pass if % Reduction >= 60% Pass ❑ Fail Option 4 used then: 4 All accessible leaks repaired using smoke. HERS rater must verify (No sampling). No smoke allowed to leak from system. Including -ducts, plenums, _air handler and door panel. Pass if all accessible le'aks`t ave been'repaired using smoke t3 Pass a Fail Reg: 212-A0038163A-M2100001A-M21A Registration Date/Time: 2012/09/13 13:53:43 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC,LTESTING z: 'CF 4•R MECH-21 9. g ... Y._V­­11(Page 2 of 2) Duct Leaks a Test Existm Duct S s, 2g Address: Enforceme 51nt'Agency: " . Permit Number: Calle Paloma, La Quinta CA 92253, (System. 1) City of La Quints 12 803 s ❑ Outside air (OA) ducts�fG during duct leakage testing C venti.l.ationis required to meet be configured tothe closed pc ❑ All supply a'nd-mre ur*n regist(' x - applies�to duct leakage com leaks) describ�ed above ❑ New duct i16stallatlons Cann S ❑ Mastic arid�drawban s mus leaks;at allsnew�duetconnectii ral Fan Integrated (CFI) ventilation.systems, shall not -be sealed/taped off A't;ducts that utilize controlled motorized dampers, that open only when OA >HRAE Standard 62.2, and close when OA ventilation is not required, may onduring duct leakage testing mance. ;sible DECLARATION STAEMENT�u� L:certifyQunder penally of perjury under theaaws of the State of California, the information provided on this form is true and correct. u n?� I am the certified HERS rater who performed. the verification services identified and reported on this certificate (responsible rater). ,. c p to The installed feature, materialgcomponent;: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 Compliance1(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 oq the Certificate(s) of Compliance (CF -SR) approved by the enforcement atencv. Builder or Installer information as shown on the Installation Certificate (CF -6R). Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) CERTIFIED COMFORT SYSTEMS INC Responsible Person's Name: CSLB License: Mark Hyde 1906115 i HERS Provider Data Registry Information Sample Group # (if applicable): 343560 Q tested/verified dwelling JNncit-teste " d/verified dwelling in a HERS samlgroup HERS Rater Information CalCERTS Certificate # CC1-1798674292 HERS Rater Company Name: Desert H.E.R.S. Raters Responsible Rater's Name: Responsible Rater's Signature: Michael Hyde Michael Hyde Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 8/23/2012 CC2005602 Reg: 212-A0038163A-M2100001A-M21A Registration Date/Time: 2012/09/13 13:53:43 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 CERTIFICATE'OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-25 Refrigerant Charge Verification 'Standard Measurement?Procedure I (Page_i of 5) Site Address: �r `° :' ":. 51-285 Calle Paloma, La Quinta CA 92253 Enforcement AgencyE " "City of La Quinta' , ' Permit Number: 12=803' Note: If installation of a Charge Indicator Display (CID) is utilized,as an alternative to refrigerant charge veriFcation for compliance, a MECH-24 Certificate (instead'of this MECH=25'Certificate) should be-used.to demonst�at6 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'hew or replacement space -conditioning systems that utilize prescriptive compliance method.' TMAH - Access Holes in SuoDiv and Return Plenums of Air Handler System Name'oe Identification/Tag Systerrm,l. System Location or Area Served Whole House 1 ❑ Yes❑ NP $ 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 .."EMS ❑ No k x; 151,16inth (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 „tolxand 2 is a pass Enter Pass -or Fail " %o',13 Pass ✓ [I Fail ... ."�. � .. System Na,;mejgrMIdeniifcation/Tag 7; r 4 '" �� - z . R' is .:. 3 ®Yes i] No The sensors facto installed% fieldtinstalled��accordin oto manufacturers rY x ��g pe f cations, or is installed by rnethods/specifications approved ryj. e�Executive ❑ Yes ❑ No specifications, or is installed by methods%specifications approved bythe Executive Directork��� Director... 4 ❑ Y,es `, e' ❑ No The senso to is terminate with standard rt ini plug su ble f6 connect aft digital thermomee a AT,�he sensor mr plu istaccessible to�the io talli g echnician [3 Yes [3 No digital thermometer. Thi sensor mini plug'i§ accessible to the installing technician andtheHERS k theairflow�throu h the and the HERS rater without changing the airflow through the condenser coil rater withoutchan m condenser coil s.-..m..a....x..xv..,:. .fi,,... `'- ...:,. g.,:9 a. .. -. g 5 ®West - ❑ No ,�' �_.. When attached to a digital thermometer, the sensor provides in:indication of the � .." ._.. saturation temperature of the coil. Yes t3;4and5isa5 applicable'; Otherwise passEnteN/Auf STMS are not enterPass or Fail7 ,/ N/A [3.❑ ✓ ?ass ✓ ❑Fail Nag STMS - Sensor on the CondenseFICoil System Name or Identification/Tag System, i . The sensor is factory installed, or, field installetl-according to manufacturer's 6 ❑ Yes ❑ No specifications, or is installed by methods%specifications approved bythe Executive Director... The sensor wire is terminated with astandard mini plug suitable for{connection to a 7 [3 Yes [3 No digital thermometer. Thi sensor mini plug'i§ accessible to the installing technician and the HERS rater without changing the airflow through the condenser coil 8 ❑ Yes❑ No When attached to a digital thermometer, the Sensor, 'provides'an indication of the saturation temperature of the coil. . Yes to 6, 7, and 8 is a pass. Enter N/A if STMS are not ®N/A ✓ ❑Pass ✓ [3 Fail applicable. Otherwise enter Pass or Fail Reg: 212-A0038163A-M2500001A-M25A Registration Date/Time:'2012/09/13 13:55:19 HERS Provider: CalCERTS; Inc. 2008 Residential Compliance Forms March 2010 CERTIFICATE'OF_FIELDUERIFICATION XjkSIXNG,i. ,CF-4R=MECH-25 _ _. Refrigerant Charge Verification Standard Measurement,Procedure(Page 2 of 5) Site Address:,- Enforcement Agency: : � 1 e660it'Number: 51-285 Calle Paloma, La'Quinta CA,92253 [City,qf.. L&.-Qpinta. 12-803; '3 Standard Charge MeasurementProcedure (for use ifoutdoor air dry-bulb is above 5500) Procedures for determining,Refriger'ant Charge using the Standard Charge Measurement Procedure areavailable. 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 most use the Alternate Charge Measurement Procedure. Space .Conditioning Systems System Name or Identification/Tag System 1 System Location or Area Served'- Whole House' Outdoor Unit Serial # Outdoor Unit Make Outdoor Unit Model Nominal Cooling Capacity Btu/hr g ' . Date of Verification Calilirafion'ofo-`.Diaariostic'Instru`ments> `> Date=of Refrigerant Gauge Ca,libratior14. `(must System 1 be re calibrated monthly) h s Date -Of Thermocouple�Calibration �IN e must bemire cal orated monthly) ' k ._ ssupplY., db ..:._ tea' �r M System Nameor Idenific tatiQn/Tag 911 System 1 h s Supply (evaporatoriRe" awng) a dry-bulb temperature+(;Trl�* ��)ell � a ' k ._ ssupplY., db ..:._ tea' �r Renu n,(evapri �orator enteng) aiKd'5ry bulb temperatu a (Treturny,db) „ .' .., q :v ... Return(evapor5 or. tertng)dair,�wet'!bulb temperature IT Evaporator saturation temperat95e-s':::i: ' (T evaporator, sat) _ Condensor saturation temperature" (Tcondensor, sat) Suction line temperature (Tsuction) Liquid Line Temperature (Tliquid) Condenser (entering) air dry-bulb temperature (Tcondenser, db) Reg: 212-A0038163A-M2500001A-M25A Registration Date/Time: 20i2/09/13 13:55:19 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE tCF 4R MECH-25 Refrigerant Charge,Verification Standard Measurement Procedure r (Page;3 of'5) Site 51 85dCalle Paloma, La Uinta CA 92253 C tgof Laenu n9adcy Permit Number: Q Y... Q'. 12-80T Minimum Airflow Requirement Temperature Split Method Calculations for determining Minimum,Airflow Requirement for. Refrigerant Charge Verification. The temperature split methodds specified in Reference"Residdirtial Appendix RA3.2. System Name or Identification/Tag t Calculate: Actual Temperature Split = Treturn,'db - Tsupply, db Target Temperature Split from Table RA3.2-3 using Treturn, wb and Treturn, db 5 Calculate difference: Actual Temperature Split - Target Temperature Split = Passes if difference is between -4°F and•+4°F or, upon remeasurement, if between -40F and -100°F Enter Pass or Fail . Note: Temperature Split Method,>Calcu/ation is not.necessary if actual Cooling Coil Airflow is'verified using one of the airflow measurement rocedOres s ecified in.Reference Residential"A p p pperic/ix RA3.3. ;If actual cooling coil airflow is ,� measured, the value must be4!equal toior greater than the Calculated Minimum Airflow Requirement in the table be/ow. . wA ` m _ Calculated Minimum Airflow Requirement (CFM) =Nominal Cooling Capacity (ton) X+300 (cfm/ton) �. Sys em'g,Name or Id nti'fication a '-4tn;- Calculated Minimum Airflow&*Requirement (GFM) >k: Measured Airflow using RA3.3�procedures (CFM) M1 NO PassesdfFrneasuredl irflow is rester than or equal � � �� to the calculatedminimum airflowreguirement� � :. Enter Pass :or Fail .; Superheat$Charge MethodCalculat ons for Refrigerant Charge Verification: This procedure is required to be used for fined orifice metering,devicesYssterns.: -t y System Name or Identification`�ag .................................. . Calculate: Actual Superheat = Tsuction - Tevaporator, sat Target Superheat'from'Table RA3.2-2 using. Treturn, wb and Tcondenser,.db Calculate difference: Actual Superheat - Target Superheat = System passes if difference is between .-6°F and +6°F Enter Pass or Fail Reg: 212-A0038163A-M2500001A-M25A Registration Date/Time: 2012/09/13 13:55:19 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATIONCERTIF,ICATE„ >_ CF 4R MECH-25 Refrigerant Charge Verification StandardMeasurement Procedure: 4:0 5) Site Address. ";; 51-285 Calle''Paloma, La.Quinta CA 92253 .. .. ..... ..,.. _.. `Enforcement Agency: city of La Quetta. .'. ...._. ... ._ Permit Number: 12-863' .. ._..... A.. Subcooling Charge Method.Calculations for Refrigerant Charge Verification. This procedure is 'required to be used for thermostatic expansion valve.(TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag Calculate: Actual Superheat .x Calculate: Actual Subcooling = Tcondenser, sat - Tliquid Target Subcooling specified by manufacturer between 3°F'and 26°F if manufacturer s S isnot aJailable). Calculate difference: Actual Subcooling - Target Subcooling = �, f, System passes if difference is between '� 'OEm -4°F and +4°F ,. Enter Pass or Fail Metering Device Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion, valve (TXV) and electronic expansion valve (EXV).systems. System Name or Identification/Tag;;;'.:,.::.. �... Calculate: Actual Superheat .x p . Tsuction-::Teya orator sate.` M Enter^allowable superh-W., ange from manufacturer ssspeeifications (or use range between 3°F'and 26°F if manufacturer s S isnot aJailable). pecification System passesifactualsuPerheat is `within tle� alloJiable superheat range - �� �, f, EntertPass or: Wail '� 'OEm ,. Reg: 212-A0038163A-M2500001A-M25A Registration Date/Time:'2012/09/13 13:55:19 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 rj INSTALLATION CERTIFICATE,., ; s , , , ., "CF -4R MECH-25 Refrigera'ntkChaege verification StandardMeasurement Procedure (Pa9e?5.of 5) Site'Address:Enforcem'ent Agency '.' . Permit Number: 51-285:Calle Paloma,'.La Quinta CA92253City_ of La_Qumta 12=803 Standard Charge Measurement 'Su'mmary." .' 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 906115 HERS Provider Data Registry Information Sample Group # (if applicable): 343560 System meets all refrigerant charge and airflow ® not-tested/verified dwelling in a HERS sample gfoup requirements. HERS Rater Company Name: Desert H.E.R.S. Raters Responsible Rater's Name: Responsible Rater's Signature: Enter Pass or Fail Michcel.Hyde . Responsible Rater's.Certification Number w/ this HERS Provider: Date Signed: $/23/2012 CC2005602' < � .. a q sl .�. DECLARATION rSTATEM ENk,1 I certify under penalty of perjury under the.laws of the State of California, the information provided on this form is true and correct. • I am the certified HERS raterwho�performed the verification services identified and reported on this certificate (responsible rater). • The installed feature, material, component or manufactured device.requiii 'HERS verification that is identified on this certificate (the installation) complies with the:a'ppl cable:requirements in Reference Residential'Appendices Wand RA3 and the requirements specified on the Certificate(s) of Compliance (.c:$R) 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 td -the requirements specified on the Certificate(s) of Compliance (CF -1R) approved by the enforcement aoencv. Builder or Installer information as shown on the Installation Certificate (CF -6R) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) CERTIFIED COMFORT SYSTEMS INC Responsible Person's Name: CSLB License: Mark Hyde 906115 HERS Provider Data Registry Information Sample Group # (if applicable): 343560 tested/verified dwelling ® not-tested/verified dwelling in a HERS sample gfoup HERS Rater Information CaICERTS•Certificate.# CCI -1798674292 HERS Rater Company Name: Desert H.E.R.S. Raters Responsible Rater's Name: Responsible Rater's Signature: Michael.Hyde Michcel.Hyde . Responsible Rater's.Certification Number w/ this HERS Provider: Date Signed: $/23/2012 CC2005602' Reg: 212-A0038163A-M2500001A-M25A Registration Date/Time: 2012/09/13 13:55:19 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 i u INSTALLATION •CERTIFICATE CF-611lt-MECH-04 Space Conditioning Systems; Ducts'and•Fans' " (Page. i of 2) Site Address: ` ' Enforcemerit'Agency: Permit Number: 51-285 Calle Paloma, La Quinta CA 92253 (System 1) City'of La Quints 12-803 , Space Conditioning Systems Heatina Eauipment Equip, Sype;± (package=; h�ieat pump): CEC Certified Mfr. Name and Model Number ARI Reference Number2 # of Identical Systems Efficiency (AFUE, etc.)1, 3 (>=CF -1R value)4 Duct Location (attic, crawl- space, etc.) Duct R -value Heating Load (kBtu/hr) Heating Capacity (kBtu/hr) Split,"`' ii?riace day night n8ms10902116a 1 80 AFUE Attic R-4.2 80 90 kBtu Type (package ARI # of and EER) 1, 3 (attic, crawl- Cooling Cooling heat pump) CEC Certified Mfr. Name and Model Numberp,',,,, Reference Number2 Identical Systems (>=CF -1R value)4 space, etc.) Duct R -value, Load (kBtu/hr) Capacity (kBtu/hr) Split day night LL13 SEER' ; A/C ,� , sc4aA42gkb200 ... R -.:; ga l ;1ItEER 1&Attic%Wl 2. X40 42 kBtu y coottny Equipment i. tr project is new construction, see?roornores to sranaaras Iaa►e i5i-rs ana taa[e i -5i -c, ror aucc ceaing airernaave compliance. 2. ARI Reference Number can'be fold by entering the equipment model. number at http://www. aridirectory. org/arijec. php# 3. Listed efficiency on this page must be greater than or equal ( ? ) to the value shown on the CF -1R form. 4. When CF -1R is reference it is also applicable to the CF -1R, CF -IR -AA or CF -IR -ALT ALL BOXES MUST BE CHECKED TO BE A VALID FORM 0 §110-§113: HVAC equipment is certified by the California Energy Commission. 0 §150(h): Heating and/or cooling loads calculated in accordance with ASHRAE, SMACNA, or ACCA. 0 §150(i): Setback Thermostat on all applicable heating and/or cooling systems meet the requirements of §112(c). 0 §150(j)2: Pipe insulation for cooling system refrigerant suction, chilled water and brine lines meets minimum requirements of Table 150-B and includes a vapor retardant or is enclosed entirely in conditioned space. Reg: 212-A0038163A-M0400001A-0000 Registration Date/Time: 2012/07/31 16:29:08 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 ( Efficiency Duct Equip [ (SEER Location Type (package ARI # of and EER) 1, 3 (attic, crawl- Cooling Cooling heat pump) CEC Certified Mfr. Name and Model Numberp,',,,, Reference Number2 Identical Systems (>=CF -1R value)4 space, etc.) Duct R -value, Load (kBtu/hr) Capacity (kBtu/hr) Split day night LL13 SEER' ; A/C ,� , sc4aA42gkb200 ... R -.:; ga l ;1ItEER 1&Attic%Wl 2. X40 42 kBtu y V 41 tlol&" AM `77.€j'777�., "'77 7 ''`= ' v•. PSH Ti •:y,.r� t� 1 i. tr project is new construction, see?roornores to sranaaras Iaa►e i5i-rs ana taa[e i -5i -c, ror aucc ceaing airernaave compliance. 2. ARI Reference Number can'be fold by entering the equipment model. number at http://www. aridirectory. org/arijec. php# 3. Listed efficiency on this page must be greater than or equal ( ? ) to the value shown on the CF -1R form. 4. When CF -1R is reference it is also applicable to the CF -1R, CF -IR -AA or CF -IR -ALT ALL BOXES MUST BE CHECKED TO BE A VALID FORM 0 §110-§113: HVAC equipment is certified by the California Energy Commission. 0 §150(h): Heating and/or cooling loads calculated in accordance with ASHRAE, SMACNA, or ACCA. 0 §150(i): Setback Thermostat on all applicable heating and/or cooling systems meet the requirements of §112(c). 0 §150(j)2: Pipe insulation for cooling system refrigerant suction, chilled water and brine lines meets minimum requirements of Table 150-B and includes a vapor retardant or is enclosed entirely in conditioned space. Reg: 212-A0038163A-M0400001A-0000 Registration Date/Time: 2012/07/31 16:29:08 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-04 Space Conditioning Systems, Ducts an&Fans. (Page 2 of 2) Site Address: Enforcement Agency: Permit Number: 51-285 Calle Paloma, La Quinta CA 92253 (System 1) City of La_ Quinta 12=803 Ducts and Fans §150(m): Duct and Fans q''1`All air -distribution system ducts and plenums installed, sealed and insulated to meet the Fe? Wbrhents of CMC Sections 601,'602, 603, 604, 605 and Standard 6-5; supply -air and return -air du , s":and plenums are insulated to a minimum installed.level of R-4.2 or enclosed entirely in. conditioned space. Openings shall be sealed with mastic, tape or other duct -closure system that meets .,,,.applicable requirements of UL 181, UL 181A, or UL 181B or aerosol sealant that meets the requirements of UL 723. If mastic or tape is used to seal openings greater than 1/4 inch, the combination of mastic and either mesh or tape shall be used; and CJ 1. Building cavities, support platforms for air handlers, and plenums defined.or constructed with materials other than sealed sheet.metal, duct board or flexible duct shall not be used for conveying conditioned air. Building cavities and support platforms may contain ducts. Ducts installed in cavities and support platforms shall not be compressed to cause reductions in the cross-sectional area of the d u cts. ❑ 2D. Joints and seams of duct systems and their components shall not be sealed with cloth back rubber adhesive duct tapes unless°such tape is used in combination with mastic and draw bands. ❑ 7. Exhaust fan systems have back draft or automatic dampers. ❑ 8. Gravity ventilating systems serving conditioned space have either automatic or readily accessible, manually operated dampers. ❑ Protection of Insulation.; Insulation shall(be protected from damage, including that due to sunlight, moisture, equipment maintenance, and wind. Cellular foam insulation shall be protected: as above or painted with a coating thaOis water retardant and provides shielding .from solar radiation that can cause degradation of.the material:", ❑ r � 10. Flexible ducts cannot have porous inner cores. a. +2 DECLARATION STATEMENT . I nder penalty of:perjury under°t certify uhe 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 responsble;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 cod es'and.lregulations, 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 -SR) form approved by the enforcement agency that identifies the specific requirements for the Installation. I certify that the requirements detailed on the CF71R that apply to the installation have been met. • I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) CERTIFIED COMFORT SYSTEMS INC Responsible Person's Name: Responsible Person's Signature: Mark Hyde Mark Hyde CSLB License: Date Signed: Position With Company (Title): 906115 7/18/2012 Reg: 212-A0038163A-M0400001A-0000 Registration Date/Time: 2012/07/31 16:29:08 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE , CF-6117MECH-21-HERS Duct Leakage Test — Existing. Duct System (Page 1 of 2) Site Address:Enforcement Agency: Permit Number: 51-285 Calle Paloma, La Quinta CA 92253 (System 1) City of La Quinta •12-803 " Enter the Duct System Name or Identification/Tag: System i Enter the Duct System Location or Area Served: Whole House. - dfe `Stibmit one Installation Certificate for each duct system that must demonstrate compliance in the du5e1%iig a; rhii installation certificate is required for compliance for alterations and additions in existing dwellings to sceCbaditioning systems and duct systems. NoteY"For existing dwellings, a completely new or replacement duct system can also include existing parts of ti original duct system (e.g., register boots, air handler, coil, plenums, etc.) if those parts are accessible >i and they can be sealed. For a completely new or replacement duct system installed in an existing dwelling, use the Installation Certificate titled "Duct Leakage Test = Completely New or Replacement, Duct System. " Duct Leakage Diagnostic Test - existing duct system Select one compliance method from the following four choices. a 1. Measured leakage less than 15% of fan flow ❑ 2. Measured leakage to outside less than 10% of Fan Flow ❑ 3. Reduce leakage by 60% and conduct smoke and fix all leaks h ❑ 4. Fix all accessible leaks using ke and HERS rater verify Note: (One of Options 1, 2 or 3 must.' attempted before utilizing Option 4.) Determine nominal -Fan Flow using'ofie of the following three calculation methods r ✓� Cool ingosystem:method: Size of,condenserhn Tonsv 3 x4001--,� ,CFM A,,tOx� ✓ ❑ ieat�ng'system methh"od Z=1 7 x•,:� utput Capaci�ty4mFThousand 0 f Btu/hr ✓❑ Measured system�airflow,,usmgrRA3 3;airflow testprocedures: tGFM Options used then �`N � a ' Allowed"leakage, 'Fan+Airflow= 1400 0 15, 210CFM'�p' J 1 x ,. g Actual Leakage Pass if Actual Leakage is less than Allowed leakage Pass Fail Option 2"used.'ttien: 2 Allowed leakage =, Fan AirfloA x 0.10 = _ CFM Actual Leakage to outside =)!CFM .. (Pass.if Actual leakage to outside is less than Allowed leakage Ej Pass Fail Option 3 used then: Initial leakage prior to start of work = _ CFM Final leakage after sealing all accessible leaks using smoke test = _ CFM 3 Initial leakage _ - Final leakage _ = Leakage reduction CFM ((Leakage reduction _ / Initial leakage _) x 100% _ % Reduction Pass if % Reduction > 60% p Pass ❑ Fail Option 4 used then: 4 All accessible leaks repaired using smoke test. HERS rater must verify (No Sampling). Pass if all accessible leaks have been repaired using smoke ❑ Pass ❑ Fail Reg: 212-A0038163A-M2100001A-0000 Registration Date/Time: 2012/07/31 16:25:48 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE r CF-6R-MECH-2I-HERS Duct Leakage Test --Existing Duct System (page 2 of 2) Site Address: Enforcement Agency: Permit Number: 51-285 Calle Paloma, La Quinta CA 92253.(System 1) City of La Quinta 12-803 0 Outside air (OA) ducts for Cen during duct leakage testing. CFI; ventilation is required to meet be configured to the closed posit 0 All supply and*return register - applies "ta4dalieakage compl leaks) described above.. 0 New duct'tinsta 0 Mastiei leaks at a I Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off 1 ducts'that utilize controlled motorized dampers, that open only when OA RAE Standard 62.2, and close when OA ventilation is not required, may i during duct leakage testing. Iding d pliance ssible DECLARATION STATEMENT • I certify under penalty of perjury, unde .the laws of the State of California, the information provided on this form Is true and correct. . I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized representative of the person responsible for construction (responsible person). • I certify that the installed features;.materials, components, or manufactured devices identified on this certificate (the installation) conforms to all. applicable codes and regulations, and the installation Is consistent with the plans and specifications approved by the enforcement agency. • I understand that a HERS rater will check the installation to verify compliance, and that that if such checking identifies defects, I am required to take corrective action at my expense. I understand that Energy Commission and HERS provider representatives will also perform quality assurance checking of installations, including those approved as part of a sample group but not checked by a HERS rater, and if those installations fail to meet the requirements of such quality assurance checking, the required corrective action and additional checking/testing of other installations in that HERS sample group will be performed at my expense. • I reviewed a copy of the Certificate of Compliance (CF -111) form approved by the enforcement agency that identifies the specific requirements for the installation. I certify, that the requirements detailed on the CF -111 that apply to the installation have been met. • I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the building permit(s) issued for the building, and, made available to the.enforceMent agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be, included. with` the, documentation the builder provides to the building owner at occupancy. I will ensure that all Installation Certificates will come from a HERS provider data registry for multiple orientation alternatives, and beginning, October 1,-2010, for all low-rise residential buildings. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) CERTIFIED COMFORT SYSTEMS INC Responsible Person's Name: Responsible Person's Signature: Mark Hyde Mark Hyde CSLB License: Date Signed: Position With Company (Title): 906115 7/18/2012 Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? ❑ Yes ❑ No H Reg: 212-A0038163A-M2100001A-0000 Registration Date/Time: 2012/07/31 16:25:48 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE* CF-611=MECH-25-HERS Refrigerant Charge Verification - Standard:•Measurement+Procedure (Pagel of 5) Site Address: Enforcement Agency: Permit Number: 51-285 Calle Paloma, La Quinta CA 92253 City of La"Quinta 12-803 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 flip Yefrigerant charge verification requirement. TMAH and SIMS are not required`for compliance, when a CID is utilized f�om�liance. i A9 Many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional form(s) for Ery, additional systems in the dwelling as applicable. Y Pnperature Measurement Access Holes (TMAH) and Saturation Temperature Measurement 3�nsors (STMS) Procedures for installing TMAH are specified in Reference Residential Appendix RA3.2. If refrigerant charge verification is uired for compliance, TMAH are also required for compliance. STMS are only required for completely new or "replacement space -conditioning systems that utilize prescriptive compliance method. TMAH - Access Holes in Supplv and Return Plenums of Air Handler System Name or Identification/Tag System 1 System Location or Area Served -Whole House 1 p Yes ❑ No 5/16 inch (8 mm) access hole upstream of evaporative coil in the return plenum and labeled according,to Figure in Section RA3.2.2.2.2. 2 p Yes ❑ No i 5/16 inch (8 mm) access. hole.downstream of evaporative coil in the supply plenum ,and labeled according to Figure in Section RA3.2.2.2.2. Yes to 1 and 2 is a pass. Enter Pass or Faill ✓ o Pass ✓ ❑ Fail L STMS - Sensor on the Evaporator.Coil — System Narnf�Iiieitification/Tag" .'._SystemiT �.,";. 3 ['Yes E`_'6 The sensor is factory"'installed or field•�installed according to�rnanufacturer's ®'No « s ecifications or is installed by methods"/specifications approved by,the Executive 4 , r Director., .� .' 4 i] Yes �1,11 k. The sensor wire is'te'rmmatfe'd w th'a standard mini plug -suitable for,connecti60,two a ' , 1'YHEkS ®,.No digital thermometer wTpe s'ensor�mim plug is;accessible'fo,th{e installing technician `, .rater without ehanginrg t e4rRrW1ffir6Ugh the condenser coil 5 ❑ Yes ❑ No, TFie, sensor measures the saturation temperature of the coil within 1%3 degrees F Yes to 3, 4Cand 51s-a� ass. Enter N/A if STMS are not P., applicable: Otherwise enter Pass or4lFail ,� 0 N/A ✓ ❑Pass ✓ ❑Fail STMS - Sensor on the Condenser. Coil System Name or Identification/Tag I System 1 The sensor is factory installed, or field installed according to manufacturer's 6 ❑ Yes ❑ No specifications, or is installed by methods/specifications approved by the Executive Director. The sensor wire is terminated with a standard mini plug suitable for connection to a 7 ❑ Yes ❑ No digital thermometer. The sensor mini plug,is accessible to the installing technician and the HERS rater without changing the airflow. through the condenser coil 8 ❑ Yes ❑ No The sensor measures the saturation temperature of the coil within 1.3 degrees F Yes to 6, 7, and 8 is a pass. Enter N/A if STMS are not p N/A ✓ ❑ Pass ✓ ❑ Fail applicable. Otherwise enter Pass or Fail 7" +'yl Reg: 212-A0038163A-M2500001A-0000 Registration Date/Time: 2012/07/31 16:25:15 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATIQN CERTIFICATE CF-6R-MECH-2S-HERS Refrigerant Charge Verification - Standard.Measurement Procedure. (Page 2 of S) Site Address:Enforcement'Agency: Permit Number: 51-285 Calle Paloma, La Quinta CA 92253 City of La' Quinta 12=803 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 My„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. flie system must meet minimum airflow requirements as prerequisite for valid refrigerant charge test. Y outdoor air dry-bulb is 55°F or below, the installer must use the Alternate Charge Measurement Procedure. :Space Conditioning Systems za System Name or Identification/Tag System i (must be re -calibrated monthly) Date of Thermocouple Calibration System Location or Area Served Whole House Outdoor Unit Serial # e1O16O497O "" -:`.� , Outdoor Unit Make day night Outdoor Unit Model c4a442gkb2OO Nominal Cooling Capacity Btu/hr 42000 Date of Verification. 7/17/2012 Calibration of Diagnostic Instruments Date of Refrigerant Gauge Calibration;' , 7/17/2012 (must be re -calibrated monthly) Date of Thermocouple Calibration r1librated monthly) ,(yam y MeasuredaTemperatures (,:F)�w iL .kg =.a Fnj F° dF,ITVL dei 0, � +�F System Name or Identification/Tag, $ p,} System]R w •.I. 5 ! ,(yam y Supply (eJap"oratorleavmg)air dry=bulbi temperature (T”) .r xw� >- suPPly, db "" -:`.� , Return (evaporator -,entering) air dry -'bulb temperaturereurn, db �= Return (evaporator entering) air wet:bulb' temperature (Treturn, wb)` Evaporator saturation temperature' 45 (Tevaporator, sat) ` Condensor saturation temperature 100 (Tcondensor, sat) Suction line temperature (Tsuction) 61 Liquid Line Temperature (Tliquid) 91 Condenser (entering) air dry-bulb 90 temperature (Tcondenser, db) ' P I Reg: 212-A0038163A-M2500001A-00.00 Registration Date/Time: 2012/07/31 16:25:15 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION, CERTIFICATE. CF-6R,MECH-25-HERS Refrigerant Charge Verification-Stand'ard'Mea'surement Procedure(Page 3'of 51 Site Address: Enforcement Agency: Permit N_ umber: 51-285 Calle Paloma, La Quinta CA 92253 City "of La'Quinta 12-803 Minimum Airflow Requirement Temperature Split Method Calculations for determining Minimum Airflow Requirement for Refrigerant Charge Verification. The temperature split method is specified in Reference Residential Appendix RA3.2. system Name or Identification/Tag System 1 Calculate: Actual Temperature Split = Treturn, .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 -3°F and +3°F or, upon remeasurement, if between -3°F and -100°F Enter Pass or Fail Note: Temperature Split Method Calculation is not necessary if actual Cooling Coil Airflow is veriFed 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 equalto or greater than the Calculated Minimum Airtlow Requirement in the table below. Calculated Minimum Airflow Requirement (CFM) Nominal Cooling Capacity, ty (ton) X 300 (cfm/ton) System Nam--eloprj Systi�so` - -� Calculated Minimum Airflow Requirerr (GF,M) 1'OSO ,. �. r I�w1'a` MeasuredsAirflow usS -procedures (CFM) 1 " �1200i�r , "s' �R,(A'3 -i`ti.'-i;:i �f.. Passes if measured airflow is,greate"r;than or equal to the calculated minimum airflowPASS requirement : Enter`Pass or Fail Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for fixed orifice metering device'systems System Name or Identification/Tag System 1 Calculate: Actual Superheat = Tsuction - Tevaporator, sat Target Superheat from Table RA3.2-2 using Treturn, wb and Tcondenser, db Calculate difference: Actual Superheat - Target Superheat = System passes if difference is between -5°F and +5°F Enter Pass or Fail Reg: 212-A0038163A-M2500001A-0000, Registration Date/Time: 2012/07/31 16:25:15 HERS Provider: CalCERTS, Inc. 2008 .Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE.CF-6R?MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5) .Site Address: Enforcement Agency: Permit Number: 51-285 Calle Paloma, La Quinta.,CA 92253 City of La Quinta 12=803? Subcooling Charge Method Calculation's for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. gy`stem Name or Identification/Tag SystemAL Calculate: Actual Superheat = Tsuction - Tevaporator, sat r4-� . 16.0 'Calculate: Actual Subcooling= 9.0 ,condenser, sat -,liquid 4-25 Target Subcooling specified by manufacturer 10 Calculate difference: -1 Actual Subcooling - Target Subcooling = -- System passes if difference is between -3°F and +3°F PASS Enter Pass or Fail Metering Device Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electrdnic expansion valve (EXV), systems. System Name or Identification/Tag System 1 Calculate: Actual Superheat = Tsuction - Tevaporator, sat r4-� . 16.0 Enter allowable superheat range frdm- manufacturer's specifications (or use range between 4°F and 25°F if manufactur*6r!s 4-25 specification is not available) System passes; ifactulil'superheat isRwithinjthe allowable superheat range "`' _ -- _ ..�. Tye.. �, . . � � '.} �� �'L. �'!�• ' } ''i 'v '2 Y• Reg: 212-A0038163A-M2500001A-0000 Registration Date/Time: 2012/07/31 16:25:15 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-;,MECH.-25-HERS Refrigerant'Charge Verification'- Standard Measurement.Procedure (Page'5 of 5) Site Address: Enfo lcement Agency: Permit Number: 51-285 Calle Paloma, La Quinta CA 92253 City of La Quinta 12-803' 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 a`pplitable verification criteria must be re -measured and/or recalculated. System Name or Identification/Tag System 1 CSLB License: Date Signed: Position With Company (Title): System meets all refrigerant charge and airflow. 7/17/2012 Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): requirements. PASS Enter Pass or Fail DECLARATION STATEMENT • I certify under penalty of perjury, under the laws of the State of California, the Information provided on this form is true and correct. • I am eligible under Division 3 of.,the Business and Professions Code to accept responsibility for construction, or an authorized representative of the person responsible for construction (responsible person). • I certify that the installed features, materials, components, or manufactured devices identified.on this certificate (the installation) conforms to all applicable codes and regulations, and the Installation is consistent with the plans and specifications approved by the enforcement agency. • I understand that a HERS rater will check the installation to verify compliance, and that that if such checking identifies defects, I am required to take corrective action at my expense. I understand that Energy Commission and HERS provider representatives will also perform quality assurance checking of installations, including those approved as part of a sample group but not checked by a HERS rater, and if those installations fail to meet the requirements of such quality assurance checking, the required corrective action and additional checking/testing of other installations in that HERS sample group will be performed at my expense. • I reviewed a copy of the Certificate of Compliance (CF -1R) form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF -111 that apply to the installation have been met. • I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the building permit(s) issued for the building' and made available to the enforcement agency for all applicable inspections. I understand that.a signetl copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. I will ensure that all Installation Certificates will come from a HERS provider data registry for multiple orientation alternatives,.and beginning October 1, 2010, for all low-rise residential buildings. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) CERTIFIED COMFORT SYSTEMS INC Responsible Person's Name: Responsible Person's Signature: Mark Hyde Mark Hyde CSLB License: Date Signed: Position With Company (Title): 906115 7/17/2012 Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? ❑ Yes ❑ No Reg: 212-A0038163A-M2500001A-0000 Registration Date/Time: 2012/07/31 16:25:15 HERS Provider: CalCER•TS, Inc. 2008 Residential Compliance Forms August 2009