12-1174 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
-12-00001174
Property Address:
76930 AVENIDA FERNANDO
APN:
658-240-020- -
Application description:
MECHANICAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
9650
Applicant:
Ta�/ 4 4 Q"
Architect or Engineer:
a/A
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
WINTERHALTER RAY
76930 AVENIDA FERNANDO EDLA QUINTA, CA 92253
Contractor:
DIAL ONE'S ONE HOUR A/
2712 E. LA CADENA DRIV
RIVERSIDE, CA 92507
(951)276-9744
Lic. No.: 878533
ccp�NE�
VOICE (760) X19-7012
FAX (760) 7
INSPECTIONS (760) 777-7153
Date: 10/04/12
2012
& HTFY CIF La QUINt�
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
_ I have and will maintain a certificate'of consent to self -insure for workers' compensation, as provided
Liven Class: C20 License No.: 878533
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
L'
ate: [V " ai C ract
issued.
1 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
OWNER -BUILDER DECLARATION
insurance carrier and policy number are: .
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
Carrier EVEREST NATL Policy Number CA10001300121
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
_ I certify that, in the performance of the work for which this permit is iss0ed, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
person in any manner so as to become subject to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions 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 forthwith comply with those provisions.
'that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
�(7�
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
ate: �a pplicant: '
(_ 1 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
WARNING: FAILURE TO SECURE WO <ERS' 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 (5100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES 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 -builder will have the burden of proving that he or she did not build or
improve for the purpose of sale.).
1 _ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
property who builds or improves thereon, and who contracts for the projects with a contractors) licensed
pursuant to the Contractors' State License Law.).
(_ 1 I am exempt under Sec. , B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address: r"
Ift
LQPERMIT
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
conditions and restrictions set forth on this application.
1. Each person upon whose behalf this application is made, each person at whose request and for
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quinta, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work is not commenced
within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the above information is correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of
this county to enter upo the above-mentioned property for inspection purposes.
Cate: —1} gnature (Applicant or Agef�E�-a c�
Application Number . . . . . 12-00001174
Permit . . . MECHANICAL
Additional desc . .
Permit Fee . . . . 40.50
Plan Check Fee
10.13
Issue Date . . . .
Valuation . . . .
0
Expiration Date . . 4/02/13
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: INSTALL 13 SEER
PACKAGE
UNIT ON ROOF IN EXISTING LOCATION. 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 to 15
Site Address:
Enforcement Agency:
Date:
Permit #:
�c&9� Av �,
Cts v
\o-�-I-;>-
Conditioned Floor
Equipment T e'
List Minimum Efficiency2
Duct insulation requirement
Area
Thermostat
Packaged Unit
Furnace
AFUE rbola
® COP
Over 40 ft of ducts added or
. Setback
Indoor Coil
ER�3
HSPF
®Resistance
re laced in unconditioned space
R 6 (CZ 10-13)
Served by system
�qZ sf
(If not already
present, must be
Condensing Unit
EER
R 8 (CZ 14-15)
installed)
Other
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -1 R -ALT -HVAC for each system.
2. Minimum Equipment Efficiencies: 13 SEER, 78%AFUE, 7.7HSPFfor 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
signed. Beginning October 1, 2010, a registered copy of the CF -1R and CF -6R shall also be on site for final inspection.
jal. HVAC Changeout
Required Forms:
• All HVAC Equipment replaced
CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH- 25 -HERS
CF -4R forms: MECH- 21 and fors lits stems MECH-25
• Condenser Coil and /or
CF -6R forms: MECH-2I-HERS and (for split systems) MECH- 25 -HERS
• Indoor Coil and/or
CF -4R forms: MECH- 21 and (for split systems) MECH-25
• Furnace
For Split Systems: Duct leakage < 15 percent; RC, CCA > 300 CFM/ton(Minimum Air Flow Requirement), TMAH
For Packaged Units: Duct leakage < 15 percent
Exempted from duct leakage testing if:
1. Duct system was documented to have been previously sealed and confirmed through HERS verification, or
2. Duct systems with less than 40 linear feet in unconditioned space, or
3. Existing ducts stems are constructed, insulated or sealed with asbestos
®2. New HVAC System
Required Forms:
• Cut in or Changeout with new
CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS
ducts: (all new ducting and all
CF -4R forms: MECH 20-, and (for split systems)MECH-22, and MECH 25
new equipment)
For Split Systems: Duct leakage < 6 percent; RC, CCA > 350 CFM/ton, FWD, TMAH, STMS, and either HSPP or PSPP.
For Packaged Units: Duct leakage < 6 percent
®3. New Ducts with/or without Replacement
Required Forms:
• Includes replacing or installing all new ducting
CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-25-HERS
and/or outdoor condensing unit and/or indoor coil
CF -4R forms: MECH-20 and (for split systems) MECH-25
and/or furnace. No or some equipment changed.
For Split Systems: Duct leakage < 6 percent, RC, CCA > 300 CFM/ton, TMAH
For Packaged Units: Duct leakage < 6 percent
4. New Ducting over 40 feet
Required Forms:
• Includes adding or replacing more than 40
CF -6R forms: MECH-04, MECH-2I-HERS CF -4R forms: MECH-21
linear feet of duct in unconditioned space.
For splits stem or packaged units: Duct leakage < 15 percent
EXCEPTION: Existing ducts stems 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.
• 1 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 I 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 ands specifications submitted to the enforcement agency for approval with the permit application.
Name: r7e� �N
,tom
Signature'
Company:
�� �a L � `D�• �
Date:
�e -1.1-12-
Address:
-P A VdI Q
License:
533
City/State/Zip: ` (� S
Phone: Q5\ 2-1(P_ -2-1- .;
2008 Residential Compliance Forms March 2010
!
i
Bin.#
Cray Of QUintd
Buiiding ST Safety Division
Permit # ��
P.O. Box 1504,-78-495 Calle Tampico
La.Quinta, CA 92253 - (760) 777-7012
Building Permit
Application and Tracking Sheet
Pro'ectAddress: `
1
wner's Name:. t k
A P. Number.
T.Address:
Legal Description:
ity, ST, Zip: CIA
j
Contractor: i�1G� ` �i
c S ... Fw..S g ;
Telephone: `ni::y
Address:'x
0.
Project Description:
City, ST, Zip: !aU Qfscaz i
C,--�—S U -7-------------
Telephone: p Cl
�; }'
00
State Lic.
Lic. #;
obArch., Engr., Designer.
Address:
City., ST, Zip:
Telephone:Construction
Type: Occupancy:
State Lic. #:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.: # Stories: #Units:
Telephone # of Contact Person:
Estimated Value of Project Cz
APPLICANT:
DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted'
"
Item Amount
Structural Cafes
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Calci.
Called Contact Person
Plan Check Balance-
Tide 24 Calci.
Plans picked up
Construction
_._
Flood plain plea
Lflaysxesubmitted ' --
--
-Mechanical
Grading plan
2'r Review, ready for correctiionsrtwue
Electrical
'
Subeontactor List
Called Contact Person
Plumbing
Gra at Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''" Review; ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees '
Total Permit Fees
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-IR-ALT-HVAC
Climate Zones 10 - 15
Site Address:
Enforcement Agency:
Date:
Permit #:
76930 Avenida Fernando La Quinta, CA 92253
City of La Quinta
Oct 10, 2012
Duct insulation
Conditioned Floor
Equipment Typel
List Minimum Efficiency2
requirement
Area
Thermostat
® Package Unit
❑ Furnace
® AFUE 78%
❑ COP
❑ R 6 (CZ 10-13)
Served by system
H Setback
❑ Indoor Coil
® SEER 13.0
❑ HSPF
❑R g ( CZ 14-15)
1500 sf
If not already present, must be
[3 Condensing Unit
[3EER
E3 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-411
forms (no hand filled CF-4Rs allowed) are filled out and signed.Beginning October 1, 2010, a registered copy of the CF-111
and CF-611 shall also be on site for final inspection.
® 1. HVAC Changeout
Required Forms:
. All HVAC Equipment
CF-6R forms: MECH-04, MECH-2I-HERS and (f8F split systems) 04reGm 25 HERS
replaced
CF-4R forms: MECH-21 and (f^- split systems) NEGH 2
. Condenser Coil and /or
CF-6R forms: MECH-04, MECH-2I-HERS and (fray systems) NEH 25 HERS
. Indoor Coil and /or
_split
CF-411 forms: MECH-21
. Furnace
For Packaged Units: Duct leakage < 15 percent
Exempted from duct leakage testing if:
❑ 1. Duct system was documented to have been previously sealed and confirmed through HERS verification, or
❑ 2. Duct systems with less than 40 linear feet in unconditioned space, or
❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos
❑ 4. The system will not be Ducted (ie.,Ductless Mini-Split System), (Also Exempt from Refrigerant Charge)
❑ 2. New HVAC System
Required Forms: r J 4
. Cut in'or Changeout with.
"
CF-6R forms: MECH-04, MECH-201HERSi and (for split systems) MEC14-22-HERS, and
new ducts: (all new /f
ducting � all new
MECH-25-HERS f ~'
��'!' L -,
CF-4R forms: MECH-20J and (for split systems) MECH-22, and ME! H-25, lF I
equipment)
r
For Split Systems: Duct leakage < 6 percent; RC, CCA >_ 350 CFM/ton, FWD, TMAH, STMS, and either HSPP or PSPP.
For Packaged Units: Duct leakage < 6 percent
❑ 3. New Ducts with/or without
Required Forms:
Replacement y
. Includes replacing or installing all new
ducting and/or outdoor condensing unit
CF-6R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS
and/or indoor coil and/or furnace. No or some
CF-4R forms: MECH-20 and (for split systems) MECH-25
equipment changed.
For Split Systems: Duct leakage < 6 percent; RC, CCA >_ 300 CFM/ton, TMAH
For Packaged Units: Duct leakage < 6 percent
❑ 4. New Ducting over 40 feet
Required Forms:
. Includes adding or replacing more than 40
CF-6R forms: MECH-04, MECH-2I-HERS
linear feet of duct in unconditioned space.
CF-4R forms: MECH-21
For split system or packaged units: Duct leakage < 15 percent
❑ EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos.
Contractor (Documentation Author's /Responsible Designer's Declaration Statement)
. I certify that this Certificate of Compliance documentation is accurate and complete.
. I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of
Compliance.
. I certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the
requirements of Title 24, Parts 1 and 6 of the California Code of Regulations.
. The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance
forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with the permit application.
Name: Ruth Debrick Signature: Ruth Debrick
Company: VENVEST BALLARD INC Date: Oct 10, 2012
Address: 2712 EAST LA CADENA DRIVE License: 878533
City/State/Zip: RIVERSIDE / CA / 92507 Phone: (951) 276-9744
Reg: 212-A0056586B-000000000-0000 Registration Date/Time: 2012/10/10 13:15:09 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms July 2010
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING
CF-4R-MECH-21
Duct Leakage Test — Existing Duct System
(Page 1 of 2)
Site Address:
76930 AVENIDA FERNANDO, La Quinta CA 92253 (System
Enforcement Agency:
Permit Number:
1)
City of La Quinta
12-1174
Enter the Duct System Name or Identification/Tag: System 1
Enter the Duct System Location or Area Served: Whole House
Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the
dwelling.
This installation certificate is required for compliance for alterations and additions in existing dwellings to
space conditioning systems and duct systems. ,
Note: For existing dwellings, a completely new or replacement duct system can also include existing parts of
the original duct system (e.g., register boots, air handler, coil, plenums, etc.) if those parts are accessible
and they can be sealed. For a completely new or replacement duct system installed in an existing dwelling,
use the Installation Certificate titled 'Duct Leakage Test - Completely New or Replacement Duct System. "
Duct Leakage Diagnostic Test - existing duct system
Select one compliance method from the following four choices.
® 1. Measured leakage less than 15% of fan flow
2. Measured leakage to outside less than 10% of Fan Flow
❑ 3. Reduce leakage by 60% and conduct smoke and fix all leaks
IJ 4. Fix all accessible leaks using smoke and HERS rater verify
Note: (One of Options.l, 2, or 3 must be attempted, before utilizing Option,4.)., — -
Determine;nominal Fan Flow using one of,the"following three calculation methods.,' '#
✓ N Cooling system method: Size of coridenser in Tons 5 x 400 = 2000 CFM
✓ ❑ Heating system method: 211.7 x Output Capacity in Thousands of Btu/hr = _ CFM
✓❑ Measured system airflow using'RA3.3 airflow'testprocedures: _CFM
Option 1 used then:
1
Allowed leakage = Fan Flow 2000 x 0.15 = 300 CFM
Actual Leakage = 150 CFM
Pass if Leakage Actual is less than Allowed
C1 Pass Fail
Option 2 used then:
2
Allowed leakage = Fan Flow_ x 0.10 = _ CFM
Actual Leakage to outside = _ CFM
Pass if Leakage Actual is less than Allowed
Pass Fail
Option 3 used then:
Initial leakage prior to start of work = _ CFM
Final leakage after sealing all accessible leaks using smoke test = _ CFM
3
Initial leakage _ - Final leakage _ = Leakage reduction CFM
((Leakage reduction _/ Initial leakage _) x 100% _ % Reduction
Pass if % Reduction >= 60%
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
E3 Pass Fail
e
Reg: 212-A0055402A-M2100001A-M21A Registration Date/Time: 2012/10/10 13:39:23 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING
CF-4R-MECH-21
Duct Leakage Test - Existing Duct System
(Page 2 of 2)
Site Address:
76930 AVENIDA FERNANDO, La Quinta CA 92253 (System
Enforcement Agency:
Permit Number:
1)
City of La Quinta
12-1174
® Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off
during duct leakage testing. CFI OA ducts that utilize controlled motorized dampers, that open only when OA
ventilation is required to meet ASHRAE Standard 62.2, and close when OA ventilation is not required, may
be configured to the closed position during duct leakage testing.
®All supply and return register boots must be;,sealed to the drywall if smoke test is utilized for compliance
- applies'to duct leakage.comp,liance option 3 (leakage reduction by,60%) and option 4''(fix all accessible
leaks) described above- �/
19 New duct installations cannot utilize building cavities as plenums or platform returns in lieu of ducts.
`. •-..,rte ' ` ( ' - ..-'' � � �:._ �. • r r �. ,� "� ��-";�
® Mastic and draw bands must be used in combination with cloth backed rubber adhesive duct tape to seal
leaks at all new duct connections.
DECLARATION STATEMENT"
• I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct.
• I am the certified HERS rater who performed the verification services identified and reported on this certificate (responsible rater).
• The installed feature, material, component, or manufactured device requiring HERS verification that is identified on this certificate (the
installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified
on the Certificate(s) of Compliance (CF -111) approved by the local enforcement agency.
• The information reported on applicable sections of the Installation Certificate(s) (CF -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 agency.
Builder or Installer information as shown on the Installation Certificate (CF -6R)
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
VENVEST BALLARD INC
Responsible Person's Name:
CSLB License:
aim McEligot
1878533
HERS Provider Data Registry Information
Sample Group # (if applicable): N/A
® tested/verified dwelling
❑ not-tested/verified dwelling in
la
HERS sample group
HERS Rater Information CalCERTS Certificate # CC1-1798697021
HERS Rater Company Name:
Athens Air
Responsible Rater's Name:
Responsible Rater's Signature:
Andrew Pulos
Andrew Pulos
Responsible Rater's Certification Number wJ this HERS Provider:
Date Signed: 10/9/2012
CC2004503
Reg: 212-A0055402A-M2100001A-M21A Registration Date/Time: 2012/10/10 13:39:23 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
INSTALLATION CERTIFICATE
CF-6R-MECH-0
Space Conditioning Systems, Ducts and Fans
(Page 1 of 2)
Site Address:
76930 dress: A FERNANDO, La Quinta CA 92253 (System
Enforcement Agency:
Permit Number:
1)
City of La Quinta
12-1174
Space Conditioning Systems
Heating Equipment
Equip
Type
(package-
heat pump)
CEC Certified Mfr. Name
and Model Number
ARI
Reference
Number2
# of
Identical
Systems
Efficiency
(AFUE,
etc.)1, 3
(>=CF-iR
value)4
Duct
Location
(attic,
crawl-
space,
etc.)
Duct
R -value
Heating
Load
(kBtu/hr)
Heating
Capacity
(kBtu/hr)
Package
Furnace
Goodman
GPG136009OM41
1
80 AFUE
I Attic
R-8
72
90 kBtu
Type
and EER)
(attic,
(package
ARI
# of
1, 3
crawl-
Cooling
Cooling
heat
pump)
CEC Certified Mfr. Name
and Model Number
Reference
Number2
Identical
Systems
(>=CF -1R
value)4
space,
etc.)
Duct
R -value
Load
(kBtu/hr)
Capacity
(kBtu/hr)
Package
A/C
—Goodman
GPG136000.990M41
f. —
f
<—,
it
r""�
13
5 /
Attic
R-8.
24 ?,
3 Tons
j
/SEER
Cooling Equipment
1. If project is new construction, see Footnotes to Standards Table 151-8 and Table 151-C for duct ceiling alternative
compliance.
2. ARI Reference Number can be found by entering the equipment model number at
http://www.aridirectory.orglarilac.php#
3. Listed efficiency on this page must be greater than or equal ( ? ) to the value shown on the CF -IR form.
4. When CF -IR is reference it is also applicable to the CF -1R, CF -IR -AA or CF -IR -ALT
ALL BOXES MUST BE CHECKED TO BE A VALID FORM
® §110-§113: HVAC equipment is certified by the California Energy Commission.
® §150(h): Heating and/or cooling loads calculated in accordance with ASHRAE, SMACNA, or ACCA.
® §150(i): Setback Thermostat on all applicable heating and/or cooling systems meet the requirements of
§112(c).
® §150(j)2: Pipe insulation for cooling system refrigerant suction, chilled water and brine lines meets
minimum requirements of Table 150-B and includes a vapor retardant or is enclosed entirely in
conditioned space.
7
Reg: 212-A0055402A-M0400001A-0000 Registration Date/Time: 2012/10/10 13:37:37 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms August 2009
Efficiency
Duct
Equip
(SEER
Location
Type
and EER)
(attic,
(package
ARI
# of
1, 3
crawl-
Cooling
Cooling
heat
pump)
CEC Certified Mfr. Name
and Model Number
Reference
Number2
Identical
Systems
(>=CF -1R
value)4
space,
etc.)
Duct
R -value
Load
(kBtu/hr)
Capacity
(kBtu/hr)
Package
A/C
—Goodman
GPG136000.990M41
f. —
f
<—,
it
r""�
13
5 /
Attic
R-8.
24 ?,
3 Tons
j
/SEER
J
1. If project is new construction, see Footnotes to Standards Table 151-8 and Table 151-C for duct ceiling alternative
compliance.
2. ARI Reference Number can be found by entering the equipment model number at
http://www.aridirectory.orglarilac.php#
3. Listed efficiency on this page must be greater than or equal ( ? ) to the value shown on the CF -IR form.
4. When CF -IR is reference it is also applicable to the CF -1R, CF -IR -AA or CF -IR -ALT
ALL BOXES MUST BE CHECKED TO BE A VALID FORM
® §110-§113: HVAC equipment is certified by the California Energy Commission.
® §150(h): Heating and/or cooling loads calculated in accordance with ASHRAE, SMACNA, or ACCA.
® §150(i): Setback Thermostat on all applicable heating and/or cooling systems meet the requirements of
§112(c).
® §150(j)2: Pipe insulation for cooling system refrigerant suction, chilled water and brine lines meets
minimum requirements of Table 150-B and includes a vapor retardant or is enclosed entirely in
conditioned space.
7
Reg: 212-A0055402A-M0400001A-0000 Registration Date/Time: 2012/10/10 13:37:37 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms August 2009
INSTALLATION CERTIFICATE
CF-6R-MECH-04
Space Conditioning Systems, Ducts and Fans
(Page 2 of 2)
Site Address:
76930 AVENIDA FERNANDO, La Quinta CA 92253 (System
Enforcement Agency:
Permit Number:
1)
City of La Quinta
12-1174
Ducts and Fans
§150(m): Duct and Fans
® 1. All air -distribution system ducts and plenums installed, sealed and insulated to meet the
requirements of CMC Sections 601, 602, 603, 604, 605 and Standard 6-5; supply -air and return -air
ducts and plenums are insulated to a minimum installed level of R-4.2 or enclosed entirely in
conditioned space. Openings shall be sealed with mastic, tape or other duct -closure system that meets
the applicable requirements of UL 181, UL 181A, or UL 181B or aerosol sealant that meets the
requirements of UL 723. If mastic or tape is used to seal openings greater than 1/4 inch, the combination
of mastic and either mesh or tape shall be used; and
® 1. Building cavities, support platforms for air handlers, and plenums defined or constructed with
materials other than sealed sheet metal, duct board or flexible duct shall not be used for conveying
conditioned air. Building cavities and support platforms may contain ducts. Ducts installed in cavities
and support platforms shall not be compressed to cause reductions in the cross-sectional area of the
ducts.
® 2D. Joints and seams of duct systems and their components shall not be sealed with cloth back
rubber adhesive duct tapes unless such tape is used in combination with mastic and draw bands.
® 7. Exhaust fan systems have back draft or automatic dampers.
® 8. Gravity ventilating systems serving conditioned space have either automatic or readily accessible,
manually operated dampers.
® Protection of Insulation. Insulation shall be protected from damage, including that due to sunlight,
moisture, equipment maintenance, and wind. Cellular foam insulation shall be protected as above or
painted with a coating that is water retardant and provides shielding from solar radiation that can cause
degradation of the material.
® 10. Flexible duds cannot have porous, inner cores.._
DECLARATION STATEMENT
. I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct.
. I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized
representative of the person responsible for construction (responsible person).
. I certify that the installed features, materials, components, or manufactured devices identified on this certificate (the installation)
conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the
enforcement agency.
. I reviewed a copy of the Certificate of Compliance (CF -1R) form approved by the enforcement agency that identifies the specific
requirements for the installation. I certify that the requirements detailed on the CF -SR 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)
VENVEST BALLARD INC dba DIAL ONE'S ONE HOUR AIR CONDITIONING AND HEATING
Responsible Person's Name:
Responsible Person's Signature:
Ruth Debrick
Ruth Debrick
CSLB License:
Date Signed:
Position With Company (Title):
878533
10/2/2012
Reg: 212-A0055402A-M0400001A-0000 Registration Date/Time: 2012/10/10 13:37:37 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms August 2009
INSTALLATION CERTIFICATE
CF-611-MECH-2I-HERS
Duct Leakage Test — Existing Duct System
(Page 1 of 2)
Site Address:
76930 AVENIDA FERNANDO, La Quinta CA 92253 (System
Enforcement Agency:
Permit Number:
1)
City of La Quinta
12-1174
Enter the Duct System Name or Identification/Tag: System 1
Enter the Duct System Location or Area Served: Whole House
Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the
dwelling.
This installation certificate is required for compliance for alterations and additions in existing dwellings to
space conditioning systems and duct systems.
Note: For existing dwellings, a completely new or replacement duct system can also include existing parts of
the original duct system (e.g., register boots, air handler, coil, plenums, etc.) if those parts are accessible
and they can be sealed. For a completely new or replacement duct system installed in an existing dwelling,
use the Installation Certificate titled "Duct Leakage Test - Completely New or Replacement Duct System. "
Duct Leakage Diagnostic Test - existing duct system
Select one compliance method from the following four choices.
® 1. Measured leakage less than 15% of fan flow
❑ 2. Measured leakage to outside less than 10% of Fan Flow
❑ 3. Reduce leakage by 60% and conduct smoke and fix all leaks
❑ 4. Fix all accessible leaks using smoke and HERS rater verify.
Note: (One of Options 1, 2 or 3 must be attempted. before utilizing, Option
Determine nominal Fan Flow using one of,the following three calculation methods.r" + r •+ T
✓ ® Cooling system method: Size of condenser in Tons f3 x 400 = / 1200 CFM
'
✓ ❑ Heating system method: 2 1.7 z Output Capac ty.in Thousandds of Btu/hr = CFM
1
test procedure's: I'
✓ 13 Measured_ system airflow using RA3.3 airflow CFM
Option 1 used then:
y
1
Allowed leakage = Fan Airflow 1200 x 0.15.= 180 CFM
Actual Leakage = 141 CFM
Pass if Actual Leakage is less than Allowed leakage
C1 Pass Fail
Option 2 used then:
2
Allowed leakage = Fan Airflow _ x 0.10 = _ CFM
Actual Leakage to outside = _ CFM
Pass if Actual leakage to outside is less than Allowed leakage
Pass 0 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 No Reduction >= 60%
Pass Fail
Option 4 used then:
4
All accessible leaks repaired using smoke test. HERS rater must verify (No Sampling).
Pass if all accessible leaks have been repaired using smoke
Cl Pass E3 Fail
+7
Reg: 212-A0055402A-M2100001A-0000 Registration Date/Time: 2012/10/10 13:37:51 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
INSTALLATION CERTIFICATE
CF-6R-MECH-2I-HERS
Duct Leakage Test - Existing Duct System
(Page 2 of 2)
Site Address:
76930 AVENIDA FERNANDO, La Quinta CA 92253 (System
Enforcement Agency:
Permit Number:
1)
City of La Quinta
12-1174
® Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off
during duct leakage testing. CFI OA ducts that utilize controlled motorized dampers, that open only when OA
ventilation is required to meet ASHRAE Standard 62.2, and close when OA ventilation is not required, may
be configured to the closed position during duct leakage testing.
® All supply and return register boots=must be,sealed to the drywall if smoke test is utilized for compliance
- applies to'duct leakage compliance option 3 (leakage reduction by 60%) and option 41(fix all -accessible
leaks) described above
®New duct installatis' cannot utilize building cavities as;plenums)or platform returns in lieu of ducts 'fes
® Mastic and draw bands must be used in combination with cloth backed rubber adhesive duct tape to seal
leaks at all new duct connections
DECLARATION STATEMENT
. I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct.
• I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized
representative of the person responsible for construction (responsible person).
. I certify that the installed features, materials, components, or manufactured devices identified on this certificate (the installation)
conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the
enforcement agency.
. I understand that a HERS rater will check the installation to verify compliance, and that that if such checking identifies defects, I am
required to take corrective action at my expense. I understand that Energy Commission and HERS provider representatives will also
perform quality assurance checking of installations, including those approved as part of a sample group but not checked by a HERS
rater, and if those installations fail to meet the requirements of such quality assurance checking, the required corrective action and
additional checking/testing of other installations in that HERS sample group will be performed at my expense.
• I reviewed a copy of the Certificate of Compliance (CF -1R) form approved by the enforcement agency that identifies the specific
requirements for the installation. I certify that the requirements detailed on the CF -1R that apply to the installation have been met.
• I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the
building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I
understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder
provides to the building owner at occupancy. I will ensure that all Installation Certificates will come from a HERS provider data
registry for multiple orientation alternatives, and beginning October 1, 2010, for all low-rise residential buildings.
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
VENVEST BALLARD INC dba DIAL ONE'S ONE HOUR AIR CONDITIONING AND HEATING
Responsible Person's Name:
Responsible Person's Signature:
Ruth Debrick
Ruth Debrick
CSLB License:
Date Signed:
Position With Company (Title):
878533
10/2/2012
Is this installation monitored by a Third Party Quality
Name of TPQCP (if applicable):
Control Program (TPQCP)? ❑ Yes ❑ No
Reg: 212-A0055402A-M2100001A-0000 Registration Date/Time: 2012/10/10 13:37:51 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-21
Duct Leakage Test — Existing Duct System (Page 1 of 2)
Site Address:
76930 Avenida Fernando, La Quinta CA 92253 (System
Enforcement A en
9 cYT
ermit Number:
2)
City of La Quinta
2-1174
Enter the Duct System Name or Identification/Tag: System 2
Enter the Duct System Location or Area Served: Whole House
Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the
dwelling.
This installation certificate is required for compliance for alterations and additions in existing dwellings to
space conditioning systems and duct systems.
Note: For existing dwellings, a completely new or replacement duct system can also include existing parts of
the original duct system (e.g., register boots, air handler, coil, plenums, etc.) if those parts are accessible
and they can be sealed. For a completely new or replacement duct system installed in an existing dwelling,
use the Installation Certificate titled 'Duct Leakage Test - Completely New or Replacement Duct System. "
Duct Leakage Diagnostic Test - existing duct system
Select one compliance method from the following four choices.
M 1. Measured leakage less than 15% of fan flow
0 2. Measured leakage to outside less than 10% of Fan Flow
3. Reduce leakage by 60% and conduct smoke and fix all leaks
0 4. Fix all accessible leaks using smoke and HERS rater verify
Note: (One of Optionsj, 2, or 3 must be attempted,before,utilizing Option,4.),,, _,r
te
Determine nominal Fan Flow using one of=the following three calculation methods./'' j +
✓ ® Cooling system method: Size of.cordenser in Tons 12.5 ,x 400 = ' 1000 CFM
t /
"
ff l' '-
0
`
✓ ❑ Heating system meth21.7 z Output Capacity ty in usands of Btu/hr = CFM
; .•e,, 1 ti
✓13 Me�ured,system airflow using'RA3.3 airflotest rocedures: CFM,,+!
Option 1 used then:
1
Allowed leakage = Fan Flow 1000 x 0.15 = 150 CFM
Actual Leakage = 132 CFM
Pass if Leakage Actual is less than Allowed
DI Pass Fail
Option 2 used then:
2
Allowed leakage = Fan Flow _ x 0.10 = _ CFM
Actual Leakage to outside = _ CFM
Pass if Leakage Actual is less than Allowed
Pass Fail
Option 3 used then:
Initial leakage prior to start of work = _ CFM
Final leakage after sealing all accessible leaks using smoke test = _ CFM
3
Initial leakage _ - Final leakage _ = Leakage reduction CFM ,
((Leakage reduction _/ Initial leakage x 100% _ % Reduction
Pass if % Reduction >= 600/6
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
J
4^,1
Reg: 212-A0056586B-M2100001A-M21A Registration Date/Time: 2012/10/10 13:44:10 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms March 2010
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-21
Duct Leakage Test - Existing Duct System (Page 2 of 2)
Site Address:
76930 Avenida Fernando, La Quinta CA 92253 (System
Enforcement Agency:
Permit Number:
2)
City of La Quinta
12-1174
® Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off
during duct leakage testing. CFI OA ducts that utilize controlled motorized dampers, that open only when OA
ventilation is required to meet ASHRAE Standard 62.2, and close when OA ventilation is not required, may
be configured to the closed position during duct leakage testing.
® All supply,,anretu
d rn register boots "'must be,sealed to the drywall if; smoke test is utilized for compliance
- applies,to duct leakage compliance option 3 '(leakage reduction by 60%) and option 4"(fix all`accessible
leaks) described above.--
C9
bove�® New duct installations cannot utilize building cavities as+plenums'or platform returns in lieu of ducts.
�, �,,_./'� (' T I r � r i. .,.-+'i ! "�r �, r �. ' �x.� • >r`-. ``.,t�= } � , � f .` J .r �- fC1
® Mastic and draw bands must be used in combination with cloth backed rubber adhesive duct tape to seal
leaks at all new duct connections.
DECLARATION STATEMENT
• I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct.
. I am the certified HERS rater who performed the verification services identified and reported on this certificate (responsible rater).
• The Installed feature, material, component, or manufactured device requiring HERS verification that is identified on this certificate (the
installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified
on the Certificate(s) of Compliance (CF -111) approved by the local enforcement agency.
• The information reported on applicable sections of the Installation Certificate(s) (CF -611), signed and submitted by the person(s)
responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -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)
VENVEST BALLARD INC
Responsible Person's Name:
CSLB License:
Ruth Debrick
1878533
HERS Provider Data Registry Information
Sample Group # (if applicable): N/A
® tested/verified dwelling
❑ not-tested/verified dwelling in
la
HERS sample group
HERS Rater Information CalCERTS Certificate # CC1-1798698508
HERS Rater Company Name:
Athens Air
Responsible Rater's Name:
Responsible Rater's Signature:
Andrew Pulos
Andrew Pulos
Responsible Rater's Certification Number w/ this HERS Provider:
Date Signed: 10/9/2012
CC2004503
Reg: 212-A0056586B-M2100001A-M21A Registration Date/Time: 2012/10/10 13:44:10 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms I March 2010
INSTALLATION CERTIFICATE CF-6R-MECH-04
Space Conditioning Systems, Ducts and Fans (Page i of 2)
Site Address:
76930 Avenida Fernando, La Quinta CA 92253 (System
Enforcement Agency:
Permit Number:
2)
City of La Quinta
12-1174
Space Conditioning Systems
Heating Equipment
Equip
Type
(package-
heat pump)
CEC Certified Mfr. Name
and Model Number
ARI
Reference
Number2
# of
Identical
Systems
Efficiency
(AFUE,
etc.)1, 3
(>=CF-iR
value)4
Duct
Location
(attic,
crawl-
space,
etc.)
Duct
R -value
Heating
Load
(kBtu/hr)
Heating
Capacity
(kBtu/hr)
Package
Furnace
Trane
4YCC3048A1075AB
1
80 AFUE
Attic
a !`^•-'� :
85.6
107 k8tu
Cooling Equipment
Equip
Type
(package
heat
pump)
CEC Certified Mfr. Name
and Model Number
ARI
Reference
Number2
# of
identical
Systems
Efficiency
(SEER
and EER)
1, 3
(>=CF -SR
value)4
Duct
Location
(attic,
crawl-
. space,
etc.)
Duct
R -value
Cooling
Load
(kBtu/hr)
Cooling
Capacity
(kBtu/hr)
13,SEER--
"Attic,---
a !`^•-'� :
f`/.-_-''�-T
4 Tons
1. If project is new construction, see Footnotes to Standards Table 151-B and Table 151-C for duct ceiling alternative
compliance.
2. ARI Reference Number can be found by entering the equipment model number at
http://www. aridirectory. org/ari/ac. php#
3. Listed efficiency on this page must be greater than or equal ( ? ) to the value shown on the CF -IR form.
4. When CF -1R is reference it is also applicable to the CF -1R, CF -IR -AA or CF -ZR -ALT
ALL BOXES MUST BE CHECKED TO BE A VALID FORM
® §110-§113: HVAC equipment is certified by the California Energy Commission.
® §150(h): Heating and/or cooling loads calculated in accordance with ASHRAE, SMACNA, or ACCA.
® §150(i): Setback Thermostat on all applicable heating and/or cooling systems meet the requirements of
§112(c).
® §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.
0
Reg: 212-A0056586B-M0400001A-0000 Registration Date/Time: 2012/10/10 13:42:11 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms August 2009
INSTALLATION CERTIFICATE CF-6R-MECH-0
Space Conditioning Systems, Ducts and Fans (Page 2 of 2)
Site Address:
76930 Avenida Fernando, La Quinta CA 92253 (System
Enforcement Agency:
9 cY�
Permit Number:
2)
City of La Quinta
12-1174
Ducts and Fans
§150(m): Duct and Fans
® 1. All air -distribution system ducts and plenums installed, sealed and insulated to meet the
requirements of CMC Sections 601, 602, 603, 604, 605 and Standard 6-5; supply -air and return -air
ducts and plenums are insulated to a minimum installed level of R-4.2 or enclosed entirely in
conditioned space. Openings shall be sealed with mastic, tape or other duct -closure system that meets
the applicable requirements of UL 181, UL 181A, or UL 181B or aerosol sealant that meets the
requirements of UL 723. If mastic or tape is used to seal openings greater than 1/4 inch, the combination
of mastic and either mesh or tape shall be used; and
® 1. Building cavities, support platforms for air handlers, and plenums defined or constructed with
materials other than sealed sheet metal, duct board or flexible duct shall not be used for conveying
conditioned air. Building cavities and support platforms may contain ducts. Ducts installed in cavities
and support platforms shall not be compressed to cause reductions in the cross-sectional area of the
ducts.
® 2D. Joints and seams of duct systems and their components shall not be sealed with cloth back
rubber adhesive duct tapes unless such tape is used in combination with mastic and draw bands.
® 7. Exhaust fan systems have back draft or automatic dampers.
® 8. Gravity ventilating systems serving conditioned space have either automatic or readily accessible,
manually operated dampers.
® Protection of Insulation. Insulation shall be protected from damage, including that due to sunlight,
moisture, equipment maintenance, and wind. Cellular foam insulation shall be protected as above or
painted with a coating that is water retardant and provides shielding from solar radiation that can cause
degradation of the material.
® 10. Flexible.ducts cannot have porous•innere.cores.
• r � ` �I �%, �� t ,
DECLARATION STATEMENT
• I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct.
• I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized
representative of the person responsible for construction (responsible person).
. I certify that the installed features, materials, components, or manufactured devices identified on this certificate (the installation)
conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the
enforcement agency.
• I reviewed a copy of the Certificate of Compliance (CF -111) form approved by the enforcement agency that identifies the specific
requirements for the installation. I certify that the requirements detailed on the CF -SR 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)
VENVEST BALLARD INC dba DIAL ONE'S ONE HOUR AIR CONDITIONING AND HEATING
Responsible Person's Name:
Responsible Person's Signature:
Ruth Debrick
Ruth bebrick
CSLB License:
Date Signed:
Position With Company (Title):
878533
10/2/2012
Reg: 212-A0056586B-M0400001A-0000 Registration Date/Time: 2012/10/10 13:42:11 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms August 2009
INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS
Duct Leakage Test — Existing Duct System (Page 1 of 2)
Site Address:
76930 Avenida Fernando, La Quinta CA 92253 (System
Enforcement Agency:
9 cY�
Permit Number:
2�
City of La Quinta
12-1174
Enter the Duct System Name or Identification/Tag: System 2
Enter the Duct System Location or Area Served: Whole House
Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the
dwelling.
This installation certificate is required for compliance for alterations and additions in existing dwellings to
space conditioning systems and duct systems.
Note: For existing dwellings, a completely new or replacement duct system can also include existing parts of
the original duct system (e.g., register boots, air handler, coil, plenums, etc.) if those parts are accessible
and they can be sealed. For a completely new or replacement duct system installed in an existing dwelling,
use the Installation Certificate titled "Duct Leakage Test - Completely New or Replacement Duct System. "
Duct Leakage Diagnostic Test - existing duct system
Select one compliance method from the following four choices.
® 1. Measured leakage less than 15% of fan flow
❑ 2. Measured leakage to outside less than 10% of Fan Flow
❑ 3. Reduce leakage by 60% and conduct smoke and fix all leaks
❑ 4. Fix all accessible leaks using smoke and HERS rater verify
Note: (One of Options 1, 2 or 3 must be attempted. before utilizing. Option.4.)_1
Determine nominal Fan Flow using one of the following three calculation methods.
✓ ® Cooling system method: Size of condenser in Tons 14 x 400 = 1600 CFM e
✓ ❑Heating 21.7 ty Thousands
system method x� -' Output Capac in of Btu/ = _CFM
✓ ❑ Measured system aiirFlow using RA3.3 airflow test procedures: _CFM ,,rF j •., �,
r�r ,
Option 1 used then:
ri
1
Allowed leakage = Fan Airflow 1600 x 0.15 = 240 CFM
Actual Leakage = 141 CFM
Pass if Actual Leakage is less than Allowed leakage
C1
Pass Fail
Option 2 used then:
2
Allowed leakage = Fan Airflow _ x 0.10 = _ CFM
Actual Leakage to outside = _ CFM
Pass if Actual leakage to outside is less than Allowed leakage
E3
Pass 13Fail
Option 3 used then:
Initial leakage prior to start of work = CFM
Final leakage after sealing all accessible leaks using smoke test = _ CFM
3
Initial leakage _ - Final leakage _ = Leakage reduction _ CFM
((Leakage reduction _/ Initial leakage x 100% _ % Reduction
Pass if % Reduction >= 60%
Pass E3 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
Cl
Pass rl Fail
9
Reg: 212-A0056586B-M2100001A-0000 Registration Date/Time: 2012/10/10 13:42:24 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms March 2010
INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS
Duct Leakage Test - Existing Duct System (Page 2 of 2)
Site Address:
76930 Avenida Fernando, La Quinta CA 92253 (System
Enforcement Agency:
Permit Number:
2)
City of La Quinta
12-1174
® Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off
during duct leakage testing. CFI OA ducts that utilize controlled motorized dampers, that open only when OA
ventilation is required to meet ASHRAE Standard 62.2, and close when OA ventilation is not required, may
be configured to the closed position during duct leakage testing.
�„'�"r.~vt r+ . "`s
M All supply,! d return register" boots,must be. sealed to the drywall if smoke test is utilized 'for
- applies to duct leakage compliance option 3 '(leakage reduction by 60%) and option +�,(fix all accessible
leaks) described above:r"-
® New duct installations' cannot utilize building cavities as plenumslor platform returns in lieu of ducts ,P'�e;
® Mastic and draw bands must be used'in combination with cloth backed rubber adhesive duct tape to seal
leaks at all new duct connections
DECLARATION STATEMENT
• I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct.
• I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized
representative of the person responsible for construction (responsible person).
. I certify that the installed features, materials, components, or manufactured devices identified on this certificate (the installation)
conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the
enforcement agency.
• I understand that a HERS rater will check the installation to verify compliance, and that that if such checking identifies defects, I am
-required to take corrective action at my expense. I understand that Energy Commission and HERS provider representatives will also
perform quality assurance checking of installations, including those approved as part of a sample group but not checked by a HERS
rater, and if those installations fail to meet the requirements of such quality assurance checking, the required corrective action and
additional checking/testing of other installations in that HERS sample group will be performed at my expense.
• I reviewed a copy of the Certificate of Compliance (CF -1R) form approved by the enforcement agency that identifies the specific
requirements for the installation. I certify that the requirements detailed on the CF -111 that apply to the installation have been met.
• I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the
building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I
understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder
provides to the building owner at occupancy. I will ensure that all Installation Certificates will come from a HERS provider data
registry for multiple orientation alternatives, and beginning October 1, 2010, for all low-rise residential buildings.
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
VENVEST BALLARD INC dba DIAL ONE'S ONE HOUR AIR CONDITIONING AND HEATING
Responsible Person's Name:
Responsible Person's Signature:
Ruth Debrick
Ruth bebrick
CSLB License:
Date Signed:
Position With Company (Title):
878533
10/2/2012
Is this installation monitored by a Third Party Quality
Name of TPQCP (if applicable):
Control Program (TPQCP)? ❑ Yes ❑ No
Reg: 212-A0056586B-M2100001A-0000 Registration Date/Time: 2012/10/10 13:42:24 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
INSTALLATION CERTIFICATE
CF-6R-MECH-0
Space Conditioning Systems, Ducts and Fans
(Page 1 of 2)
Site Address:
76930 AVENIDA FERNANDO, La Quinta CA 92253 (System
Enforcement Agency:
Permit Number:
1)
City of La Quinta
12-1174
Space Conditioning Systems
Heating Equipment
Equip
Type
(package-
heat pump)
CEC Certified Mfr. Name
and Model Number
ARI
Reference
Number2
# of
Identical
Systems
Efficiency
(AFUE,
etc.)1, 3
(>=CF -1R
value)4
Duct
Location
(attic,
crawl-
space,
etc.)
Duct
R -value
Heating
Load
(kBtu/hr)
Heating
Capacity
(kBtu/hr)
Package
Furnace
Goodman
GPG136009OM41
�s/ �
1
80 AFUE
Attic
R-8
72
90 kl3tu
Cooling Equipment
Equip
Type
(package
heat
pump)
CEC Certified Mfr. Name
and Model Number
ARI
Reference
Number2
# of
Identical
Systems
Efficiency
(SEER
and EER)
1, 3
(>=CF -1R
value)4
Duct
Location
(attic,
crawl-
space,
etc.)
Duct
R -value
Cooling
Load
(kBtu/hr)
Cooling
Capacity
(kBtu/hr)
Package
A/C
%,—Goodman r- r
GPG336,0�09�0M41) r
�s/ �
,-N r^
11
! _-; I"
13 SEER
N fir-...
Attic
: /
� R-8
�% _7
24 ,
3 Tons
1. If project is new construction, see Footnotes to Standards Table 151-B and Table 151-C for duct ceiling alternative
compliance.
2. ARI Reference Number can be found by entering the equipment model number at
http://www.aridirectory. org/ari/ac. php#
3. Listed efficiency on this page must be greater than or equal ( ? ) to the value shown on the CF -1R form.
4. When CF -IR is reference it is also applicable to the CF -1R, CF -IR -AA or CF -IR -ALT
ALL BOXES MUST BE CHECKED TO BE A VALID FORM
® §110-§113: HVAC equipment is certified by the California Energy Commission.
® §150(h): Heating and/or cooling loads calculated in accordance with ASHRAE, SMACNA, or ACCA.
® §150(i): Setback Thermostat on all applicable heating and/or cooling systems meet the requirements of
§112(c).
® §150(j)2: Pipe insulation for cooling system refrigerant suction, chilled water and brine lines meets
minimum requirements of Table 150-B and includes a vapor retardant or is enclosed entirely in
conditioned space.
Reg: 212-A0055402A-M0400001A-0000 Registration Date/Time: 2012/10/10 13:37:37 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms August 2009
INSTALLATION CERTIFICATE
CF-6R-MECH-0
Space Conditioning Systems, Ducts and Fans
(Page 2 of 2)
Site Address:
76930 AVENIDA FERNANDO, La Quinta CA 92253 (System
Enforcement Agency:
Permit Number:
i)
City of La Quinta
12-1174
Ducts and Fans
§150(m): Duct and Fans
IN 1. All air -distribution system ducts and plenums installed, sealed and insulated to meet the
requirements of CMC Sections 601, 602, 603, 604, 605 and Standard 6-5; supply -air and return -air
ducts and plenums are insulated to a minimum installed level of R-4.2 or enclosed entirely in
conditioned space. Openings shall be sealed with mastic, tape or other duct -closure system that meets
the applicable requirements of UL 181, UL 181A, or UL 181B or aerosol sealant that meets the
requirements of UL 723. If mastic or tape is used to seal openings greater than 1/4 inch, the combination
of mastic and either mesh or tape shall be used; and
111. Building cavities, support platforms for air handlers, and plenums defined or constructed with
materials other than sealed sheet metal, duct board or flexible duct shall not be used for conveying
conditioned air. Building cavities and support platforms may contain ducts. Ducts installed in cavities
and support platforms shall not be compressed to cause reductions in the cross-sectional area of the
ducts.
® 2D. Joints and seams of duct systems and their components shall not be sealed with cloth back
rubber adhesive duct tapes unless such tape is used in combination with mastic and draw bands.
IN 7. Exhaust fan systems have back draft or automatic dampers.
® 8. Gravity ventilating systems serving conditioned space have either automatic or readily accessible,
manually operated dampers.
® Protection of Insulation. Insulation shall be protected from damage, including that due to sunlight,
moisture, equipment maintenance, and wind. Cellular foam insulation shall be protected as above or
painted with a coating that is water retardant and provides shielding from solar radiation that can cause
degradation of the material.
® 10. Flexible.ducts cannot have porous, inner cores.,_.,
t, �..,. .. Wit" - 1/ ` , .,.r_f'' r �` ', ..•��' ��+. .._.-,� , -'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 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 -SR) form approved by the enforcement agency that Identifies the specific
requirements for the installation. I certify that the requirements detailed on the CF -1R that apply to the installation have been met.
• I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the
building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I
understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder
provides to the building owner at occupancy.
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
VENVEST BALLARD INC dba DIAL ONE'S ONE HOUR AIR CONDITIONING AND HEATING
Responsible Person's Name:
Responsible Person's Signature:
Ruth Debrick
Ruth bebrick
CSLB License:
878533
Date Signed:
10/2/2012
Position With Company (Title):
Reg: 212-A0055402A-M0400001A-0000 Registration Date/Time: 2012/10/10 13:37:37 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms August 2009
INSTALLATION CERTIFICATE
CF-611-MECH-2I-HERS
Duct Leakage Test — Existing Duct System
_ (Page 1 of 2)
Site Address:
76930 AVENIDA FERNANDO, La Quinta CA 92253 (System
Enforcement Agency:
Permit Number:
1)
City of La Quinta
12-1174
Enter the Duct System Name or Identification/Tag: System 1
Enter the Duct System Location or Area Served: Whole House
Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the
dwelling.
This installation certificate is required for compliance for alterations and additions in existing dwellings to
space conditioning systems and duct systems.
Note: For existing dwellings, a completely new or replacement duct system can also include existing parts of
the original duct system (e.g., register boots, air handler, coil, plenums, etc.) if those parts are accessible
and they can be sealed. For a completely new or replacement duct system installed in an existing dwelling,
use the Installation Certificate titled "Duct Leakage Test - Completely New or Replacement Duct System. "
buct Leakage Diagnostic Test - existing duct system
Select one compliance method from the following four choices.
® 1. Measured leakage less than 15% of fan flow
2. Measured leakage to outside less than 10% of Fan Flow
0 3. Reduce leakage by 60% and conduct smoke and fix all leaks
0 4. Fix all accessible leaks using smoke and HERS rater verify
Note: (One of Options 1, 2 or 3 must be attempted, before. utilizing, Option 4.)_
Determine nominal Fan Flow using one ofjthe following three calculation methods.'
f
✓ 11 Cooling system method: Size of condenser in Tons 13 x 400 = 11200 CFM
✓0 Heating system method 21.7 x'i Output Capacity in Thousands of'Btu/hr = CFM
✓ airflow procedures: /
using'RA3.3 airflow test
0 Measured system CFM
Option 1 used then:
r
1
Allowed leakage = Fan Airflow 1200 x 0.15 = 180 CFM
Actual Leakage = 141 CFM
Pass if Actual Leakage is less than Allowed leakage
Pass Fail
Option 2 used then:
2
Allowed leakage = Fan Airflow _ x 0.10 = _ CFM
Actual Leakage to outside = CFM
Pass if Actual leakage to outside is less than Allowed leakage
Pass Fail
Option 3 used then:
Initial leakage prior to start of work = CFM
Final leakage after sealing all accessible leaks using smoke test = _ CFM
3
Initial leakage _ - Final leakage _ = Leakage reduction _ CFM
((Leakage reduction _/ Initial leakage__) x 100% _ % Reduction
Pass if % Reduction >= 60%
Pass Fail
Option 4 used then:
4
All accessible leaks repaired using smoke test. HERS rater must verify (No Sampling).
Pass if all accessible leaks have been repaired using smoke
Cl
Pass r3 Fail
Reg: 212-A0055402A-M2100001A-0000 Registration Date/Time: 2012/10/10 13:37:51 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
INSTALLATION CERTIFICATE
CF-6R-MECH-2I-HERS
Duct Leakage Test - Existing Duct System
(Page 2 of 2)
Site Address:
76930 AVENIDA FERNANDO, La Quinta CA 92253 (System
Enforcement Agency:
Permit Number:
1)
City of La Quinta
12-1174
® Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off
during duct leakage testing. CFI OA ducts that utilize controlled motorized dampers, that open only when OA
ventilation is required to meet ASHRAE Standard 62.2, and close when OA ventilation is not required, may
be configured to the closed position during dud leakage testing.
® All supplyland retum
rn register boots,ust be,sealeoke te
d to the drywall if smst is utilized for,"compliance
- applies to duct leakage compliancd option 3 '(leakage reduction by 60%) and option 4';(fix all'accessible
leaks) described above.'"
® New duct instal lations.cannot utilize building cavities ashplenums or platform returns in lieu "of ducts,']j
® Mastic and draw bands must be used in combination with cloth backed rubber adhesive duct tape to seal
leaks at all new duct connections
DECLARATION STATEMENT
. I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct.
. I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized
representative of the person responsible for construction (responsible person).
. I certify that the installed features, materials, components, or manufactured devices identified on this certificate (the installation)
conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the
enforcement agency.
. I understand that a HERS rater will check the installation to verify compliance, and that that if such checking identifies defects, I am
required to take corrective action at my expense. I understand that Energy Commission and HERS provider representatives will also
perform quality assurance checking of installations, including those approved as part of a sample group but not checked by a HERS
rater, and if those installations fail to meet the requirements of such quality assurance checking, the required corrective action and
additional checking/testing of other installations in that HERS sample group will be performed at my expense.
. I reviewed a copy of the Certificate of Compliance (CF -1R) form approved by the enforcement agency that identifies the specific
requirements for the installation. I certify that the requirements detailed on the CF -1R that apply to the installation have been met.
. I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the
building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I
understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder
provides to the building owner at occupancy. I will ensure that all Installation Certificates will come from a HERS provider data
registry for multiple orientation alternatives, and beginning October 1, 2010, for all low-rise residential buildings.
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
VENVEST BALLARD INC dba DIAL ONE'S ONE HOUR AIR CONDITIONING AND HEATING
Responsible Person's Name:
Responsible Person's Signature:
Ruth Debrick
Ruth bebrick
CSLB License:
Date Signed:
Position With Company (Title):
878533
10/2/2012
Is this installation monitored by a Third Party Quality
Name of TPQCP (if applicable):
Control Program (TPQCP)? ❑ Yes ❑ No
Reg: 212-A0055402A-M2100001A-0000 Registration Date/Time: 2012/10/10 13:37:51 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010