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12-0152 (MECH)•, j .• r :tit 44 P.O. BOX 1504 VOICE (760) 777-7012 78-495 CALLE TAMPICO. FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT `- Date: 2/17/12 ,Application Number. R' 12=00000152' Owner: Property Address: c-53400 AVENIDA'VELASCO SHARI THOENE APN: 774-085-008-8 . -000000- 53400 AVENIDA VELASCO Application description: MECHANICAL LA QUINTA, CA 92253 Property Zoning: COVE RESIDENTIAL Application valuation: 6679 Contractor: Applicant: Architect or Engineer: HYDES 42949 MADIO "STREE•T' 4 INDIO, CA 92201 (760)360-2202 ("rte rl� Lic. No.: 9061],5' F MA .. ------------------------------------------------------------------------------ --++���------- - - - - -- - LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLA71ATd0 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 License Class: C20 C36 ense No:: 906115 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is / .r1 y /Date: ri•� / -ontractor: 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 NORGUARD INS Policy Number CEWC243358 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 issued, 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 the Labor Code, I shall forthwith co 1 those prov'sidns. that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by J `�2- � � any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: e: [ ( bcant: (_) 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 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 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.). - APPLICANT ACKNOWLEDGEMENT (_ 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 is performed under or pursuant to any permit issued as a result of this application, (_) I am exempt under Sec. , B.&P.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 (Sec. 3097, Civ. C.). Lender's Name: Lender's Address: 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 permit to cancellation: 1 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 aut prize representatives of this this enter upon the above-mentioned Property for i ecti poses. D Si ure (Applicant or Agent): LQPERMIT Application Number . . . . 12-00000152 Permit MECHANICAL Additional desc . Permit Fee 40.50 Plan Check Fee'. 10.13 . Issue Date . . . . - Valuation 0 Expiration Date.. .. 8/15/12 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 9.0000 EA MECH FURNACE <=100K 9.00 1.00 16.5000 -EA --MECH B/C >3-15HP/•>100K-500KBTU 16.50 ------------------------------------------------------------------------------- Special Notes and Comments A/C CHANGE -OUT, 3 TON 14.5 SEER. HEAT PUMP & AIR HANDLER. 2010 CODES. -----------------_--------------------------------------- Other Fees . . . . BLDG STDS ADMIN (SB1473) 1.00 -Fee summary Charged ---------- Paid Credited ------------=------- Due ---------------------------- Permit Fee Total 40.50 .00. .00 40.50 Plan Check Total 10.13 .00 .00 10.13 Other Fee Total 1.00 .00 00 1.00 Grand Total 51.63 .00 ..00 51.63 Simplified''PnescroptivL-.`Ceo'tificatd,of:Compli'ance:2008.'Residenti!tOVAC.A/terations •CF-1R-ALT-HVAC Climate Zones 10 - 15`-, Site Address::: `� , .. Enforcement AgehCy:' Date: Permit #: 53-400 'Avenida'Velasco La�Quinta; CA'92253'. City of�La Quilita' '.' `` Feb 13, 2012' "Duct insulation Conditioned Floor Equipment Typel List Minimum Efficiency2 requirement Area Thermostat ❑ Package Unit p Furnace ❑n'door Coil - ❑AFUE.I p SEER 13.0. ❑ COP ' `_ 0 HSPF 7,7 0 R 6, (CZ 10-13) Served by system Setback' If not already present, must be ® Condensing Unit ❑ EER 77— .❑ Resistance ❑ R 8 (CZ 14-15) ; 1200 sf• installed) ❑ Other 1. Equipment Type: Choose the equipment being installed; if more than one system; use another CF-1R-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 CF6R 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 for final inspection. 0 1. HVAC Changeout Required Forms: . All HVAC Equipment CF-6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH725-HERS. .replaced CF-4R forms: MECH-21 I11NOand (for split systems) MECH-25 . Condenser Coil-and/or /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 leakagei< '15percent; RC, CCA 5 300 CFM/ton (Minimum Air Flow Requirement), TMAH , -9 RPFr-PRt Exempted from duct leakage testing1f:,, . ❑ 1.' Duct system was documented to have been previously sealed and confirmed through HERS verification, or [12. Duct systems with less th66`;40 linear-feet in unconditioned space, or ; ❑.3. Existing duct systems are constructed, insulated or sealed with asbestos ❑;4. The systerrrwill not tie Dined•(ie Auctless�Mm Sp�ht�kSyste. (Also Exempt from Refrigerant G large) ❑ 2. Ney�HVAC`Syste-m Requifedt'Forrns Cut Inor Changeout with°°" new ducts pall new }; �Nr" CF 6, forms MECH-04, MECI+2 HERS, andw(for split systems) MECF 22 HERS, and '' ducting and all new , (MECH-25zHERS t K� 4 lax - f CFR4Rs.foi_ _ 20, and (for split:s stems) MECH:22, and MEGFI= 25 egwpment). .!mECH a For Split Systems Duct.leakage�j 6-percent, RC; CCA'-1350 CFM/ton;a,FWD;�TMAH; SIMS, and either;NSPP-or PSPP. {' For Packaged Units: Duct leakage,<,6' er'cent.' p ❑ 3..New Ducts.:with/or without;' Required Forms:. Repla'ceme'nth - . Includes replacing or installing aIl,hew - 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 furna&e N'o or some CF-4R forms: MECH-20 and (for split systems) MECH-25 , equipment changed. _ For Split Systems: Duct leakage < 6 percent;. RC, CCA >_ 300 CFM/ton, TMAH For Packaged Units: Duct leakage < 6 percent 114. New Ducting over 40 feet ? Required Forms: . Includes adding or replacing more than 40 CF-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 p 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: Feb 13, 2012 ' Address: 42-949 MADIO STREET L1 License: 906115 City/State/Zip: INDIO / CA / 92201 Phone: (760) 360-2202 Reg: 212-A0007905A-00000000-0000 Registration Date/Time: 2012/02/13 14:39:06 HERS Provider: Ca10ERTS, Inc. _ 2008 Residential Compliance Forms + July 2010 Bin # Permit # �9-./ Project Address: 5` OQ A. P. Number: r Description: ctor: Gr°J s: Z City, ST, Zip: .C� Telephone: State Lic. # 195 Arch., Engr., Designer: Address: City, ST, Zip: Telephone: State Lic. #: Name of Contact Person: Telephone # of Contact Person: # Submittal Plan Sets Structural Calcs. Truss Cales. Energy Cales. Flood plain plan Grading, plan Subcontactor List Grant Deed H.O.A. Approval IN FIOUSE:- Planning Approval Pub. Wks. Appr School Fees City Of La Quinta Building & Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Owner's Name: Address: C70 I City, ST, Zip: /1 t C Telephone: 90-16 -75 Sq �t 6 Project Description:__, CityLic. #: t`% 9ZZ Ve_1 ZZ< Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo Sq. Ft.: # Stories: # Units: Estimated Value of Project: �' APPLICANT: DO NOT WRITE BELOW THIS LINE TRACKING Plan Check submitted PERMIT FEES Reviewed, ready for corrections Item Amount Plan Check Deposit Called Contact Person Plan Check Balance Plans picked up Coustruction Plans resubmitted Mechanical 2"" Review, ready for corrections/issue Electrical Called Contact Person Plumbing Plaus picked up S.M.I. Plans resubmitted Grading 3W Review, ready for corrections/issue Developer Impact Fee Called Contact Person A_I.P.P. Date of permit issue Total Permit Fees CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-21 Duct Leakage Test - Existing Duct System (Page 1 of 2) Site Address: 53-400 Avenida Velasco, La Quinta CA 92253 (System Enforcement Agency: City of La'Quinta Permit Number: 12-152 1) Note:`(One of Options�l, 2, 0'r.3 midst. -be attempted-before-utilizing,Option 4-)�i,: ?' Determine nominal Fan Flow using one ofrthe following three calculation methods d( ✓ ❑ Cooling method the Duct System Name or Identification/Tag: the Duct System Location or Area Served: Submit one Installation Certificate for each duct system that must demonstrate compliance in th 7g. 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. J ❑ 1. Measured leakage less than .15% Reg: 212-A0007905A-M2100001A-M21A Registration Date/Time: 2012/03/2016:28:38 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 of fan Flow `- ❑ 2. Measured leakage to ouisidAess than 10% of Fan Flow ❑ 3. Reduce leakage by 60% and�onduct smoke and fix all leaks , ;Y ❑ 4 ;Fix all, acce sable:leaks using smoke and HERS rater verify - Note:`(One of Options�l, 2, 0'r.3 midst. -be attempted-before-utilizing,Option 4-)�i,: ?' Determine nominal Fan Flow using one ofrthe following three calculation methods d( ✓ ❑ Cooling method system Size of condenser m Tons {� x 400 GFM*3 ,x; r. r Y # g` _ • y pZvi zF t y w. ✓ ❑ HeabngA,system method '21 7 x Output Capacity m,Thousands"of Btu/hrx= 1.CF,M yrt F ] '� ❑ Measured; system airflow;usin RA3,3 airflow test roce duces =r CFM Option' fused then +'ax 4' y' 1 Allowed,leakage =Fan Flow 0 15 = CFM : Actual Leakage , - . CFM f Pass if Leakage Actual is less than Allowed Pass ❑ Fail Option'2 used then ,`N ,<• - 2 Allowed leakage = Fan'Flow 1 .:z 0.10 = _CFM , Actual Leakage to outside.= 1� "' CFM Pass if Leakage Actual is less than Allowed 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 % Reduction > 60% 0 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 leaks have been repaired using smoke ❑ Pass p Fail Reg: 212-A0007905A-M2100001A-M21A Registration Date/Time: 2012/03/2016:28:38 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 r Reg: 212-A0007905A-M2100001A-M21A Registration Date/Time: 2012/03/2016:28:38 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: 53-400 Avenida Velasco, La Quinta CA 92253 (System Enforcement Agency: Permit Number:,', ' 1) City of La Quinta 12-152 . - ic ❑ 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'.requir'ed:to meet;-4SHRAE 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;reglster boots must be sealedito the drywallw,I,,smoke test Is>utilized�fol compliance - applies to=duet leakage. compliance option 3. (ieakage reductlon�by` 60%) .and option 4 (flx�all accessible , leaks) described aboveK �4 r� f� T3o a:I f� • �`�.''.. � � , � „ � �± � . g ,?�° _ ` f "� ��� ❑ New duct rnstaHations cannot;1A as'�olenums or'platform returns In Ileu��f ducts .0 Mastic and `d raw'-bands;raiust be,:used In combination witFi-cloth;backedirubber,_edheslve duct tape Eo sealA'' '^ :leaks at all new duct,connectlons': k :,... tU DECLARATION STATEMENTU,=' I certify under penalty of pequry underxthe aaws of the State of California, the Information provided on this form is true and correct. I am the certified HERS rater who performed the verification services Identified and reported on this certificate (responsible rater). ► • The installed feature, material, component, or manufactured device requiring HERS verification that is Identified on this certificate (the Installation) complies with the applicable requirements In Reference Residential Appendices RA2 and RA3 and the requirements specified on the Certificate(s) of Compliance (CF -1R) approved by the local enforcement agency: - • The information reported on applicable sections of the Installation Certificate(s) (CF -611), signed and submitted by the person(s) responsible for the installation conforms to the requirements specified on the Certificates) of Compliance (CF -1R) approved by the enforcement agency. Builder or Installer information as shown on the InstallationCertificate (CF-6R)' Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) CERTIFIED COMFORT SYSTEMS INC J Responsible Person's Name: CSLB License: Mark Hyde 1906115 HERS Provider Data Registry Information Sample Group # (if applicable): 294936 ❑ tested/verified dwelling © not-tested/verified dwelling in a HERS sample group HERS Rater Information Ca10ERTS Certificate # CC1-1798629986 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: 2/29/2012 CC2005602 , 1 , i Reg: 212-A0007905A-M2100001A-M21A Registration Date/Time: 2012/03/20 16:28:38 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms` � March 2010 I k CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-25 Refrigerant Charge Verification.- Standard Measurement Procedure (Page 1 of 5) Site Address: Enforcement Agency: Permit Number: 53-400 Avenida Velasco, La Quinta CA 92253 City of La QL 1 12-152 Note: If installation of a Charge Indicator Display (CID) is utilized as an alternative to refrigerant charge verification for compliance, a MECH-24 Certificate (instead of this MECH-25 Certificate) should be used to demonstrate compliance with the refrigerant charge verification requirement. TMAH and STMS are not required for compliance, when a CID is utilized , for compliance. As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional form(s) for,. any additional systems in the dwelling as applicable. Temperature Measurement Access Holes (TMAH) and Saturation Temperature Measurement Sensors (STMS) Procedures for installing TMAH are specified in Reference Residential Appendix RA3.2. If refrigerant charge verification is " required for compliance, TMAH are also required for compliance. STMS are only required for completely new or - replacement space -conditioning systems that utilize prescriptive compliance method. TMAH - Access Holes in Supplv and Return Plenums of Air Handler + STMS- Sensor -on -the Eva orator: Coil ' System Name or Identification/Tag System Location or Area Served - 1 ❑ Yes ❑ No '' 5/16 inch (8 mm) access hole upstream of evaporative coil in the return plenum and labeled according to Figure in Section RA3.2.2.2.2. ' 2 ' ❑ Yes ❑ No +'frdand5/16 inch (8 mm) access hole downstream of evaporative coil in the supply plenum labeled according to Figure in Section RA3.2.2.2.2. Yes to •l.and_2 �is,a.pass. , ,;�..: �;• . • Enter Pass or Fail ✓ E] Pass System •Name or.Identification/Tag��',�'''`„�' �� .:�';s� � ;;, 3'vr�!.��`;T;:4) '��.. ,4*:; ; ` 3 ❑Yes ' ❑zNo t The sensor --is factory` installed; orifieldsinstalled according to'manufacturersZ ; .o specifications, or is�installed by'methods/specification§ approved by� a Executwet`- ❑ Yes ❑ No r.';e .;. Director.. ,� _, r€ €: K, • Director. The sensory Wi"re is terminated.,with afstandard mini plug suitable for_connection to a ✓ p Fail STMS- Sensor -on -the Eva orator: Coil ' System Name or Identification/Tag System Location or Area Served - 1 ❑ Yes ❑ No '' 5/16 inch (8 mm) access hole upstream of evaporative coil in the return plenum and labeled according to Figure in Section RA3.2.2.2.2. ' 2 ' ❑ Yes ❑ No +'frdand5/16 inch (8 mm) access hole downstream of evaporative coil in the supply plenum labeled according to Figure in Section RA3.2.2.2.2. Yes to •l.and_2 �is,a.pass. , ,;�..: �;• . • Enter Pass or Fail ✓ E] Pass System •Name or.Identification/Tag��',�'''`„�' �� .:�';s� � ;;, 3'vr�!.��`;T;:4) '��.. ,4*:; ; ` 3 ❑Yes ' ❑zNo t The sensor --is factory` installed; orifieldsinstalled according to'manufacturersZ ; .o specifications, or is�installed by'methods/specification§ approved by� a Executwet`- ❑ Yes ❑ No r.';e .;. Director.. ,� _, r€ €: K, • Director. The sensory Wi"re is terminated.,with afstandard mini plug suitable for_connection to a 4 ,h ❑Yes �;�p`No The sensor wire is terminated with a standard mini plug suitable for connection to a. digitat;thermometer The sensor mrni plug,is accessible to th'ermstallingxtechnician ❑ Yes s., ;`e,, rZ tti'condenser coil'. and thefHERS'rate;without; changmgtheiairflow;throughe 5't ❑Yes.. ❑ No When attached to:a digital thermometer, the:sensor provides an,indication of the saturation temperature the ❑ Yes ❑ No When attached to a digital thermometer, the sensor provides an indication of thesaturation of coil. Yes to 3;';4- and'S;is'a`pass.:Enter :N/A-.ifSTMS are not applicable. Otherwise enf&.. Pass:or.Fail ✓ .[IN/A ✓ ❑ Pass ✓ ❑ Fail STMS - Sensor on the Condenser'Coil System Name or Identification/Tag • f sensor is factory installed, or field installed according to manufacturer's ❑ Yes ❑ No specifications, or is installed by methods/specifications approved by the a Executive„ -. • Director. The sensor wire is terminated with a standard mini plug suitable for connection to a. ❑ Yes ❑ No digital thermometer. The sensor mini plug is accessible to the installing technician RacThe and the HERS rater without changing the airflow through the condenser coil ❑ Yes ❑ No When attached to a digital thermometer, the sensor provides an indication of thesaturation temperature of the coil. , 7, and 8 is a pass. Enter N/A if STMS are notm N/A ✓ ❑Pass ✓ ❑Fail le. Otherwise enter Pass or Fail Reg: 212-A0007905A-M2500001A-M25A Registration Date/Time: 2012/03/20 16:30:40 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 • f Reg: 212-A0007905A-M2500001A-M25A Registration Date/Time: 2012/03/20 16:30:40 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 FIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECI igerant Charge Verification - Standard Measurement Procedure (Page 2 4 Address: Enforcement Agency: Permit Number: 100 Avenida Velasco, La Quinta CA 92253 Cityof La Quinta 12-152 Standard Charge Measurement Procedure (for use if outdoor air dry-bulb is above SSQF) Procedures for determining Refrigerant Charge using the Standard Charge Measurement Procedure are available in Reference Residential Appendix RA3.2. As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional form(s) for any additional systems in the dwelling as applicable. a • The system should be installed and charged in accordance with the manufacturer's specifications before startir g. this procedure. • The system must meet minimum airflow requirements as prerequisite for a valid refrigerant charge test. • If outdoor air dry-bulb is 55°F or below, the installer must use the Alternate Charge Measurement Procedure. Space Conditioning Systems System Name or Identification/Tag (must be re -calibrated monthly) • System Location or Area Served �ic�-�i r '.'�, � � Date of Thermocouple;Calibration K (fit 3r .;�•'r+"r tS+. yi{ c. X (must be re -calibrated monthly) Outdoor Unit Serial # y Outdoor Unit Make Outdoor Unit Model Return (evaporator entering) airdr -bulb Nominal Cooling Capacity Btu/Hr:�- Return (evaporator entering).air wet=bulb , Date of Verification '� Evaporator saturation temperature Calibration -of Diagnostic.Instruments.. - Date of. Refrigerant Gauge Calibration. j (must be re -calibrated monthly) • ;m ;� �ic�-�i r '.'�, � � Date of Thermocouple;Calibration K (fit 3r .;�•'r+"r tS+. yi{ c. X (must be re -calibrated monthly) P, y Measured.Temperatures"'(-°F`) �` Systemor Identifi na 9 't�,` Y �f. ;m ;� ?' �k, Su I e"va orator leaven "air d •bulb PP Y,( P 9) rY temperature (TsuPPIY, db� Return (evaporator entering) airdr -bulb Return (evaporator entering).air wet=bulb , temperature (Treturn, wb);' Evaporator saturation temperature (Tevaporator, sat) Condensor saturation temperature (Tcondensor, sat) . Suction line temperature (Tsuction) Liquid Line Temperature (Tliquid) denser (entering) air dry-bulb r perature (Tcondenser, db) y s r 4 � Reg: 212-A0007905A-M2500001A-M25A Registration Date/Time: 2012/03/20,16:30:40 HERS Provider: CalCERTS,.Inc. 2008 Residential Compliance Forms - March 2010 INSTALLATION CERTIFICATE - CF-4R-MECH-25 Refrigerant Charge- Verification - Standard Measurement Procedure (Page 3 of 5) Site Address: Enforcement Agency: Permit Number:., 53-400 Avenida Velasco; La Quinta CA 92253 City of La Quinta . 12-152 Minimum Airflow Requirement Temperature Split Method Calculations for determining Minimum Airflow Requirement for Refrigerant Charge Verification. The temperature split method is specified in Reference Residential Appendix RA3.2. System Name or Identification/Tag ' Calculate: Actual Temperature Split = Treturn, db - - Tsupply db Target Temperature Split from Table RA3.2-3 using Treturn, wb and Treturn, db Calculate difference: Actual Temperature Split - Y Target Temperature Split = :� Passes if difference is between -4°F and +4°F or, upon remeasurement, if between -4°F and -100°F Enter Pass or Fail „ Note: Temperature Split Method Calculation is not necessary if actual Cooling Coil Airflow is verifies/ using one of the airflow measurement procedcres'specified in Reference Residential Appendix RA3.3. If actual cooling coil airflow is measured, the value must be equal to,or greater than the Calculated Minimum Airflow Requirement in the table below. ' Calculated Minimum Airflow Requirement (CFM) = Nominal Cooling Capacity (ton) X 300 (cfm/ton) Syst6n 1Namey,de-Identification/Tag Calculat4,,M'iriiihum AirflowdRequirement,(CFM) A '� , -•�� -jy P` ••�-�,I��l. � S. 'ix-c "Fi... � +rte>'i.._ � } ie � 4 �.]ia:n�,�'- » �^'�-, r..�"':-+' V S , w�{ i Measure Aiur,flow (CFM) Mj'.; ff3y $' QS y it-tY ✓ y �ugs�ng�RA33,pr$oced.ureys �'a,z�d.`.�� Passes'if ineasured'airflowis>greater than, -6r equal to the calculated minimum airflow` requirement . x-'-:` '•� .''� `' ,>- a , _ • Enter. Pass or. Fail E 1 Ab Y i -Reg: 212-A0007905A-M2500001A-M25A Registration Date/Time: 2012/03/20 16:30:40; HERS Provider:.CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for fixed orifice metering.device sy'ste'ms;; System Name or IdentificationJTag;, ' 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 INSTALLATION CERTIFICATE CF-411-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5) Site Address: Enforcement Agency: Permit Number: 53-400 Avenida Velasco, La Quinta CA 92253 City of La Quinta 1 112-152 Subcooling Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag Calculate: Actual Subcooling = , Tcondenser, sat - Tliquid Target Subcooling specified by manufacturer Calculate difference: Actual Subcooling - Target Subcooling = System passes if difference is between -4°F and +4°F Enter Pass or Fail Metering Device Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag- Calculate: Actual Superheat:=; x Tsuction - Tevaporator, sat - Enter allowable superheat range from;.: manufacturer's specifications (or use range between. 3°F and 26°F, if manufacturer,'s',. specification is not available) System.'passes*if actual superheat is withi rthe, allowable superheat range f�.,v fi� �j, �t: i, 'o a"• EntercPass or. Fail n a �.f- t I ` s Or A .4` f.. � a y,,�� .. b•. . • �a`�eT°� Vic. � � 3 r'�' Fa•`�.,,�yR.. 7 '; ��:, s..`. �m +i .,`A'4e.:�� ,�",'�r"�s .r . • . a f Reg: 212-A0007905A-M2500001A-M25A Registration Date/Time: 2012/03/20 16:30:40 HERS'Provider:_ SalCERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure • (Page 5 of 5) Site Address: Enforcement Agency: Permit Number: 53-400 Avenida Velasco, La Quinta CA 92253 City of La Quinta 12-152 Standard Charge Measurement Summary: y + 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 r A ox k Sample Group # (if applicable): 294936 System meets all refrigerant charge and airflow © not-tested/verified dwelling in 9 a HERS sample group requirements. HERS Rater Company Name: Desert H.E.R.S. Raters Responsible Rater's Name: Responsible Rater's Signature: Enter Pass or Fail Michael Hyde - Responsible Rater's Certification Number w/ this HERS Provider: Date Signed:. 2/29/2012 ' CC2005602 C 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-wha performed the verification services Identified and reported on this certificate (responsible rater). . The Installed feature, material;' '; 1 rient, or manufactured device requiring HERS verification that Is Identified on this certificate (the installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified ' on the Certificate(s) of Compliance (CF -1R) approved by the local enforcement agency. . The Information reported on applicable sections of the Installation Certificate(s) (CF -6R), signed and submitted by the person(s) responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -111) approved by the enforcement aaencv. e _ Builder or Installer information as shown on the Installation Certificate (CF -6111) .fi iC Responsible Person's Name: CSLB License: r A ox HERS Provider Data Registry Information Sample Group # (if applicable): 294936 ' © not-tested/verified dwelling in 9 a HERS sample group HERS Rater Information CalCERTS Certificate # CC1-1798629986 HERS Rater Company Name: C 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-wha performed the verification services Identified and reported on this certificate (responsible rater). . The Installed feature, material;' '; 1 rient, or manufactured device requiring HERS verification that Is Identified on this certificate (the installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified ' on the Certificate(s) of Compliance (CF -1R) approved by the local enforcement agency. . The Information reported on applicable sections of the Installation Certificate(s) (CF -6R), signed and submitted by the person(s) responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -111) approved by the enforcement aaencv. e _ Builder or Installer information as shown on the Installation Certificate (CF -6111) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) , CERTIFIED COMFORT SYSTEMS INC Responsible Person's Name: CSLB License: Mark Hyde 1906115 HERS Provider Data Registry Information Sample Group # (if applicable): 294936 ' © not-tested/verified dwelling in 9 a HERS sample group HERS Rater Information CalCERTS Certificate # CC1-1798629986 HERS Rater Company Name: Desert H.E.R.S. Raters Responsible Rater's Name: C 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-wha performed the verification services Identified and reported on this certificate (responsible rater). . The Installed feature, material;' '; 1 rient, or manufactured device requiring HERS verification that Is Identified on this certificate (the installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified ' on the Certificate(s) of Compliance (CF -1R) approved by the local enforcement agency. . The Information reported on applicable sections of the Installation Certificate(s) (CF -6R), signed and submitted by the person(s) responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -111) approved by the enforcement aaencv. e _ Builder or Installer information as shown on the Installation Certificate (CF -6111) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) , CERTIFIED COMFORT SYSTEMS INC Responsible Person's Name: CSLB License: Mark Hyde 1906115 HERS Provider Data Registry Information Sample Group # (if applicable): 294936 ❑ tested/verified dwelling . © not-tested/verified dwelling in a HERS sample group HERS Rater Information CalCERTS Certificate # CC1-1798629986 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:. 2/29/2012 ' CC2005602 Reg: 212-A0007905A-M2500001A-M25A Registration Date/Time: 2012/03/20.16:30:40 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms R March 2010 INSTALLATION CERTIFICATE CF-6R-MECH-04 Space Conditioning Systems, Ducts and Fans (Page 1 of 2) Site Address: 53-400 Avenida Velasco, La Quinta CA 92253 (System Enforcement Agency: Permit Number: 1) ' City of La Quinta 12=152 Space Conditioning, Systems Heating Equipment cooling Equipment � b 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 f - Duct R -value w Cooling Load (kBtu/hr) ' Cooling Capacity . (kBtu/hr) Split Heat Pump 'american standard 4a6h5036e1000ac . F, *'3637681. —"� , 1 . Efficiency Location - R-4.2 ; k 36 kBtu Equip (AFUE, (attic, -•,.Z• Type M ✓if, �'+IP1.2 : - ARI # of ' etc.)1, 3 crawl-• ' - Heating •Heating (package- CEC Certified Mfr. Name Reference - ° Identical (>=CF -1R space, Duct Load Capacity heat pump) and Model Number Number2 �. Systems value)4 etc.) R -value (kBtu/hr) (kBtu/hr) Split american standard 'Heat Pump 4tee3f39a1000aa ' 1 9 HSPF Attic R-4.2 28 31 kl3tu cooling Equipment � b 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.) f - Duct R -value w Cooling Load (kBtu/hr) ' Cooling Capacity . (kBtu/hr) Split Heat Pump 'american standard 4a6h5036e1000ac . F, *'3637681. —"� , 1 . 15-SEER—ft,1' � 13 EER' • -.Attic ) - R-4.2 ; i33 36 kBtu `" -•,.Z• .a. M ✓if, �'+IP1.2 : - �* `Af�••/ u — :i':•'M""` p' .�.' {4.� t.�yv�yr `� 't+3 �•y v�I# Yif yam'•` s 1. it project IS new Construction, see rootnotes to btanaaras ladle 1S1-tl ana lawe 1S1 -C ror 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# Iy , i 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 -IR -ALT . a ALL BOXES MUST BE CHECKED TO BE A VALID.FORM ' 0 §1.10-§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 4' minimum requirements of Table' 150-B and includes a vapor retardant or is enclosed entirely in conditioned space. Reg: 212-A0007905A-M0400001A-0000 Registration Date/Time: 2012/02/21 11:32:48 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: 53-400 Avenida Velasco, La Quinta CA 92253 (System Enforcement Agency: Permit Number: 1) City of La Quinta 12-152 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 fog 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, 1 5 1. ° 0,10. Flexible ducts cannot have.porous inner cor_es.,;., 3. •t;,..� .,��,�.. 7i,!:.y-,.F ' ` - la'"'. vat ...r..r.� ........,s' f." , `� +ra• s f a - , 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 -1R that apply to the installation have been met: - ' • I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder ' provides to the building owner at occupancy. - Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) CERTIFIED COMFORT SYSTEMS INC f' Responsible Person's Name: Responsible Person's Signature: Mark Hyde y Mark Hyde CSLB License: _ 906115 Date Signed: 2/10/2012 position With Company (Title): Reg: 212-A0007905A-M0400001A-0000 Registration Date/Time: 2012/02/21 11:32:48 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms August 2009 4 INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS Duct Leakage Test - Existing Duct System (Page i of 2) Site Address: Enforcement Agency: Permit Number: - 53 -400 Avenida Velasco,'La Quinta CA 92253 (System City of La Quinta 12-152 1) 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 space conditioning systems and duct systems. to y 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. 0 1. Measured leakage less than 15% of fan Flow ❑ 2. Measured leakage to outside less than X10% 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.), Determinenominal Fan,"Flow using one'.of the -following three`calculatiori methods. p� , ✓ 0 Coolingisystem method: Size of condenser in Tons 3 .x 400 = 1200 CFM'- jr #- ✓ 11 Heating, system method: 21.7 x Output Capacity in Thousands of Btu/hr = _CFM ✓ El Measured _ system airflow using RA3_3 airflow test procedures:"" CFM„ -S— Option 1,used then: : i - 1 ^180 - 1 Allowed leakage = Fan Airflow 1200 x0:15 = CFM Actual Leakage•= 161 CFM — •\,. I Pass if Actual Leakage is less than Allowed leakage M Pass Fail Option 2 used then:\ 2 Allowed leakage = Fan,Airflow _ x 0.10 = _ CFM Actual Leakage to outside,= I CFM Pass if Actual leakage to outside is less than Allowed leakage Pass 13 Fail Option 3 used then: Initial leakage prior to start of work = _ CFM Final leakage after sealing all accessible leaks using smoke test = _ CFM 3 Initial leakage_ - Final leakage _ = Leakage reduction CFM ((Leakage reduction _/ Initial leakage__) x 100% _ % Reduction Pass if % Reduction > 60% ❑ Pass ❑ Fail Option 4 used then: 4 All accessible leaks repaired using smoke test. HERS rater must verify (No Sampling). Pass if all accessible leaks have been repaired using smoke ❑ Pass ❑ Fail Reg: 212-A0007905A-M2100bO1A-0000 Registration Date/Time: 2012/02/21 11:29:58 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 • ,r INSTALLATION CERTIFICATE. CF-6R-MECH-2I-HERS Duct Leakage Test - Existing Duct System (Page 2 of,2) Site Address: - = " , .` -, '4 537400 Avenida Velasco, La Quinta CA 92253 (System, Enforcement Agency: ` Permit Number: 1) " r' i • ' City'of La Quinta 12-152 f - © 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." . - 0 All supplyandreturn registerlbootsimust..belsealedtto the drywalrif smoke test -Ag utilized for'compliance R - applies4to.d6ct leakage compli'ance,option 3'(leakage;reduction by 609/o)rend option�47(fix'ali!6ccessible leaks) described above. ,3 +•` rt-� : , ' -� 1 D New duct installations,cannot utilize building cavities as plenums o rplatform�refurns —in—lieu o ducts., fYf1 i • Mastic and'draw bandsimust be,usedtin combination with clotWbacked rubber adhesive duct3ta0e 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 s 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 4 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: 906115 Date Signed: • 2/10/2012 Position With Company (Title): ' Is this installation monitored by a Third Part y Quality Name of TPQCP (if applicable): - .- Control Program (TPQCP)? - ❑Yes ❑ No Reg: 212-A0007905A-M2100001A-0000 Registration Date/Time: 2012/02/21 11:29:58 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms , March 2010 ' e ` ♦ � � - fir. ,• -d } 3 Note: If installation of ai Charge Indicator Display (CID) is utilized as an alternative to refrigerant charge verification for ' compliance, a MECH-24•Certificate (instead of this MECH-25 Certificate) should be used to demonstrate compliance with the refrigerant charge verification requirement. TMAH and STMS are not required for compliance, when a CID is utilized for compliance. • As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional form(s) for any additional systems in the dwelling as applicable. + Temperature Measurement Access Holes (TMAH) and Saturation Temperature Measurement Sensors (STMS) 1. ' , , ' Procedures for installing TMAH are specified in Reference. Residential Appendix RA3.2. If refrigerant charge verification is 1, required for compliance, TMAH are also required for compliance. STMS are only required for completely new or ' - replacement space -conditioning systems that utilize prescriptive compliance method. TMAH - Access Holes in Supply and Return Plenums of Air Handler . System. Name or Identification/Tag System 1 System Location or Area Served Whole House , I. 1 p Yes. �❑ No 5/16 inch (8 mm) access hole upstream of evaporative coil in the return plenum and labeled according to Figure in Section RA3.2.2.2.2. 2 p Yes • ❑ No 5/16 inch (8 mm) access hole downstream of evaporative coil in the supply plenum and labeled according to'Figure in Section RA3.2.2.2.2. Yes to 1 and 2 is a pass. Enter Pass or Fail -/ 0 Pass ✓ ❑ Fail STMS•- Sensor on the Eva orator.Coil,, System Nametoir Identification/Tag l /,?;,�.O`el � . System 1 ~*tel it ; -. ], tt ,j Z t, I V 3 :,� ❑Yes p""N`oi� ,/ The''sensor is factory' installed, or field installed according to manufacturer's specifications, or is installed by methods`/5pecifications approved by the Executive y ❑ Yes,' ` � �,�• / Difector. 4 El k4& ❑ No-digital'therm`omefer. The sensor wire is` terminated with a.standard mini plug suitable for connection to''a""# The senso ,, nini plug is, accessible to,Eheiinstalling,technicianl' ; '% ,,p • : ^ .�':; and the HERS rater without changing the airflow through the condenser coil 5 ❑ Yes - ❑ No The sensor measures the saturation temperature of the coil within 1.3 degrees F Yes.to.3,�4, and 5 is a''pass. Enter N/A if STMS are not applicable. Otherwise enter Pass orFail' ✓ p N/A ✓ [3 Pass ✓ ❑Fail ( /- : ' STMS - Sensor on the Condenser Coil ' System Name or Identification/Tag System 1 i . t- 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. 1 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 ,i p N/A - ✓ [:]Pass ✓ ❑ Fail applicable. Otherwise enter Pass or.Fail„ - i Reg: 212-A0007905A-M2500001A-0000 Registration Date/Time: 2012/02/21 11:29:03 HERS Provider: Ca10ERTS, Inc. ' 2008 Residential Compliance Forms August 2009 ' I i . t- C` r i Reg: 212-A0007905A-M2500001A-0000 Registration Date/Time: 2012/02/21 11:29:03 HERS Provider: Ca10ERTS, Inc. ' 2008 Residential Compliance Forms August 2009 ' I i . t- i Reg: 212-A0007905A-M2500001A-0000 Registration Date/Time: 2012/02/21 11:29:03 HERS Provider: Ca10ERTS, Inc. ' 2008 Residential Compliance Forms August 2009 ' I INSTALLATION CERTIFICATE '' • CF-6R-MECH-25-HERS ' Refrigerant Charge Verification- Standard Measurement Procedure ,' - (Page'2 of,5) ' Site Address:,Enforcement Agency: Permit Number: - •53-400 AvenidVelasco, La Quinta CA 92253 `. City of La Quinta 12-152 Standard Charge Measurement Procedure (for use if outdoor air dry-bulb is above 550F)� Procedures for determining Refrigerant Charge using the Standard Charge Measurement Procedure are available in Reference Residential Appendix RA3.2. As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional form(s) for any additional systems in the dwelling as applicable. ' • The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure. , % • The system must meet minimum airflow requirements as prerequisite for a valid refrigerant charge test. ; v • If outdoor air dry-bulb is 55°F or below, the installer must use the Alternate Charge Measurement Procedure. Space Conditioning Systems , t System Name or•Identification/Tag '• System 1 a:• •; Date of The Calibration ;r �, . System Location or Area Served •' 5 , Outdoor Unit Serial # 11134y4e4f f . +, %e' %V Outdoor Unit Make american INSTALLATION CERTIFICATE '' • CF-6R-MECH-25-HERS ' Refrigerant Charge Verification- Standard Measurement Procedure ,' - (Page'2 of,5) ' Site Address:,Enforcement Agency: Permit Number: - •53-400 AvenidVelasco, La Quinta CA 92253 `. City of La Quinta 12-152 Standard Charge Measurement Procedure (for use if outdoor air dry-bulb is above 550F)� Procedures for determining Refrigerant Charge using the Standard Charge Measurement Procedure are available in Reference Residential Appendix RA3.2. As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional form(s) for any additional systems in the dwelling as applicable. ' • The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure. , % • The system must meet minimum airflow requirements as prerequisite for a valid refrigerant charge test. ; v • If outdoor air dry-bulb is 55°F or below, the installer must use the Alternate Charge Measurement Procedure. Space Conditioning Systems , t System Name or•Identification/Tag '• System 1 a:• •; Date of The Calibration ;r �, . System Location or Area Served Whole House jq , Outdoor Unit Serial # 11134y4e4f f . +, %e' %V Outdoor Unit Make american Return (evaporator entering) air dry-bulb*+ standard Outdoor Unit Model 4a6h5036e1000ac Return (evaporator entering) air wret-bulb , Nominal Cooling Capacity Btu/hr 36000 _ Evaporator saturation temperature 33 Date of Verification 2/10/2012 ' } LauDration of wagnostic instruments . Date of Refrigerant Gauge Calibration f. 2/10/2012 (must be re -calibrated monthly) Date of The Calibration ;r *�„ ; 2/10/2012 n ,(must be re -calibrated monthly) jq Measured Temperaturesl(_'F) r ix.df •,J. ' - ; ;F: • iiO4 - ' I - ` i `"'' • K s X_ A S stem Name or Identification/Ta System 1Of Supply (evaporator leaving),air dry -bulb -4 .• " "'" .r temperature;(TS'upply' `, f . +, %e' %V u PPyI db) . A Return (evaporator entering) air dry-bulb*+ temperature•(Tretum;'"db) Return (evaporator entering) air wret-bulb , temperature (Treturn, wb), `t, '! , Evaporator saturation temperature 33 (Tevaporator, sat) } Condensor saturation temperature 94 (Tcondensor, sat) ,- Suction line temperature (Tsuction) 57 t Liquid Line Temperature (Tliquid) 86 i J Condenser (entering) air dry-bulb 80 temperature (Tcondenser, db) • z, , . ry 1 ' • ,I 1 f . • Y i Reg: 212-A0007905A-M2500001A-0000,, Registration Date/Time: 2012/02/21 11:29:03 HERS Provider: Ca10ERTS,•Inc. 2008 Residential Compliance'Form '.r `' August 2009 INSTALLATION' CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification- Standard Measurement Procedure (Page 3 of 5) Site Address: Enforcement Agency: Permit Number: 53-400 Avenida Velasco, La Quinta CA 92253 City of La Quinta 1.12-152 V - 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 f Calculate: Actual Temperature'Split = Treturn, , db - Tsupply, db 4 1 1` Target Temperature Split from Table RA3.2-3 T using Treturn, wb and Treturn, db Calculate difference: Actual Temperature Split - _ Target Temperature Split = " Passes if difference is between -30F and +3°F or,.. upon remeasurement, if between -3°F and _ r -100°F Enter Pass or Fail - 4 Note: Temperature Split Method Calculation is not necessary if actual Cooling Coil Airflow is verified using one *of the airflow measurement procedures specified in Reference Residential Appendix RA3.3. If actual cooling coil airflow is measured, the value must be equal to or greater than the Calculated Minimum Airflow Requirement in the table below. Calculated Minimum Airflow Requirement (CFM) Nominal Cooling Capacity ty (ton) X 300 (cfm/ton) System N e,oe-Id n Fication/Tag ;/'- Systmi yt- � .wry . J !°' �Minimum tv � Sa .••. r Calculated Airflow- Requirement (CFM) a 90y • Af / • Measured Airflow using RA3:3 procedures (CFM)�, ..117SI—pe �� " ,J , 'Y � •- Passes if measured airflow is greater.than or ; " ,•' equal to the calculated, minimum airflow, requirement:--'-'. '� r PASS r 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 f Calculate: Actual -Superheat = , Tsuction - Tevaporator, sat Target Superheat from Table RA3.2-2 using Treturn, wb and Tcondenser, db 1. Calculate difference: _ Actual Superheat - Target Superheat System passes if difference is between -5°F and ' +5°F Y» , -Enter _ r Pass or -Fail Reg: 212-A0007905A-M2500001A-0000 Registration Date/Time: 2012/02/21 1_1:29:03 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms .. August 2009 Subcooling Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems.' ' System Name or Identification/Tag System 1 ` Calculate: Actual Subcooling = 8.0 4 r Tcondenser, sat - Tliquid 24.E r„• Target Subcooling specified by manufacturer 8 ;. Enter allowable superheat range from , Calculate difference: 4_25 ,* ; . �.•' Actual Subcooling - Target Subcooling = ., System passes if difference is between . 4t -3°F and +3°F PASS ' • t }�' Enter Pass or Fail `' {{ r,`F .f . r i . t z . Metering Device Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag System 1 ` t 4 Calculate: Actual Superheat = 24.E Metering Device Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag System 1 Calculate: Actual Superheat = 24.E Tsuction " Tevaporator, sat ;. Enter allowable superheat range from , manufacturer's specifications (or use range , 4_25 - between 4°F and 25°F if manufacturer's ., specification is not available) a System passes` if'actual'superheat is*within,the"- allowable superheat range -% :r` " �*,,. '� �`"� �tC� ` PASSE` ` �<. d • t }�' -A".Enter Pass or, Fail `' {{ r,`F .f . r i . t z . '`'tib. �}. •+-v'=4...tt ^'s'. '�}r � '.�r;<�s C �• '� 4 �.' ' .�.c ?. � ;`n. -r y - s Reg:,212-A0007905A-M2500001A-0000 Registration Date/Time: 2012/02/-21.11:29:03 HERS•Provider: CalCERTS, Inc.. 4 2008 Residential Compliance Forms �� + August 2009 Standard Charge Measurement Summary: , System shall pass both refrigerant charge criteria, metering device criteria (if applicable), and minimum cooling coil airflow criteria based on measurements taken concurrently during system operation. If corrective actions were taken, all applicable verification criteria must be re -measured and/or recalculated. System Name or Identification/Tag System 1 , CSLB License: 906115 Date Signed: 2/10/2012 Position With Company (Title):- + System meets all refrigerant charge and airflow Name of TPQCP (if applicable): Control Program (TPQCP)? ❑ Yes ❑ No requirements. PASS Enter Pass or Fail s. ` • • y • r • • a A Owl'X,J. _ �� t. .�. ♦ S •�!` �s._i� d°•' 't .cc 1�rl A4 DECLARATIONSTATEMENT it • '' • I certify under penalty of perjury, under the laws of the State of California, the Information provided on this form is true and correct. • I am eligible under Division 3 of.the Business and Professions Code to accept responsibility for construction, or an authorized representative of the person responsible for construction (responsible person). " , • I certify that the installed features, materials, components, or manufactured devices identified on this certificate (the installation) conforms to all applicable codes and regulations, and the installation Is consistent with the plans and specifications approved by the - - enforcement agency. • I understand that a HERS rater will check the installation to verify compliance, and that that if such checking identifies defects; I am „ required to take corrective action at my expense: I understand that Energy Commission and HERS provider representatives will also perform quality assurance checking of installations; including those approved as part of a sample group but not checked by a HERS ` rater, and if those installations fail to meet the requirements of such quality assurance checking, the required corrective action and additional checking/testing of other installations in that HERS sample group will be performed at my expense. • I reviewed a copy of the Certificate of Compliance (CF -111) form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF -111 that apply to the installation have been met. Y • I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the 4 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: a Responsible Person's Signature: Mark Hyde Mark Hyde CSLB License: 906115 Date Signed: 2/10/2012 Position With Company (Title):- + Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? ❑ Yes ❑ No Reg: 212-A0007905A-M2500001A-0000 Registration Date/Time: 2012/02/21 11:29:03 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August,2009