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12-0189 (MECH)
P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number:.. 12 OR0:0,00=18:9 Property Address: �. 45055 SPRING O QCT APN: 604-291-007-7 -23995 Application description: MECHANICAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 6300 Applicant: Architect or Engineer: + LICENSED CONTRACTOR'S DECLARATION 4 4Q". BUILDING & SAFETY DEPARTMENT BUILDING PERMIT I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. Lic nse Class: C20 License No.: 878533 Date- 1 J1% �ntractor: ID / OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I arr�-eJmpvfrom the Contractor's State License Law for the - following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than.five hundred dollars ($500).: (_ 1 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within _ one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). (_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves.thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.l. I—) I am exempt under Sec. B.&P.C. for this reason Date: "Owner: CONSTRUCTION LENDING AGENCY 1 hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: Lender's Address LQPERMIT Owner: LEWIS JAMES E 46055 SPRINGBROOK CT LA QUINTA,.CA 92253 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 3/01/12 Contractor: DIAL ONE'S ONE HOUR A/!HTG I 2712-E. LA CADENA DRIi L 2012 ; RIVERSIDE, CA 92507 i (951)276:-9744 ; f:CfYsjl;;^ Lic. No.: 878533. - ---------------------------------------------- - WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty. of perjury one of the following declarations: _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued . I Have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier INS CO OF WEST Policy Number WSD500334901 I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if. I should become subject to the workers' compensation provisions of Section 11 1 3700 of the Labor Code, I shall forthwith comply with those provisions. pplicant: . �AQ , WARNING: FAeURE TO SECURE WOR(ERS COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PE LTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION'TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. - 1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or.pursuant to any permit issued as a result of this application, the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quints, 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 /Ofs un y to enter upon a above-mentioned prope y for inspection purposes. 3 1 1nature (Applicant or Agent): LQPERMIT Application Number . . . . . 12-00000189 Permit . . . MECHANICAL Additional desc . Permit Fee . . . . 26.00 Plan Check Fee 6.50 Issue Date Valuation . . . . 0 Expiration Date .. 8/28/12 Qty Unit Charge Per Extension BASE FEE 15.00 1.0.0 11.0000 EA MECH FURNACE >100K 11.00 ---------------------------------------------------------------------------- Special Notes and Comments REPLACE 60,000 BTU FURNACE & COIL IN SAME LOCATION (ATTIC).. 2010 CODES. ------------------------------- ---------------------------------------- Other. Fees . . . . . . . . BLDG STDS ADMIN (SB1473) ----- 1.00 , .Fee summary Charged Paid Credited Due Permit Fee Total 26.00 .00 .00 26.00 Plan Check Total 6.50 .00 .00 6.50 • Other Fee Total 1.00 - .00 .00 1.00 Grand Total 33.50 .00 .00 33.50 LQPERMIT Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-IR-ALT-HVAC Climate Zones 30 - 15 Site Address: Enforcement Agency: Date: Permit 71: 45055 SPRING BROOK COURT La Quinta, CA 92253 City of La Quinta Feb 27, 2012 Equipment Typel List Minimum Efficiency2 Duct insulation requirement Conditioned Floor Area Thermostat ❑ Package Unit ® Furnace 10 Indoor Coil [3 AFUE 80% ❑ SEER ❑ COP13 ❑ HSPF R 6 (CZ 10 13) Served by system ® Setback If not already present, must be ❑ Condensing Unit ❑ EER ❑ Resistance ❑ R 8 (CZ 14-15) 3500 sf 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, 7.7HSPF for typical residential systems. HERS VERIFICATION SUMMARY Listed below are FOUR HVAC alteration Options. The installer decides what work is being done and picks one of the appropriate Options. Each Option lists the HERS measures that must be conducted. A copy of the forms shall be left on site for final inspection and a copy given to the homeowner. At final, the inspector verifies that the work listed on this form was in fact the work completed by the installer. The inspector also verifies that each appropriate CF-611 and registered CF-4R forms (no hand filled CF-411s 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. m 1. HVAC Changeout Required Forms: .All HVAC Equipment CF-6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS replaced CF-4R forms: MECH-21 11 iNOand (for split systems) MECH-25 . Condenser Coil and /or . Indoor Coil and /or CF-6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS . Furnace CF-411 forms: MECH-21 and (for split systems) MECH-25 For Split Systems: Duct leakage < 15 percent; RC, CCA <_ 300 CFM/ton (Minimum Air Flow Requirement), TMAH Pop Paeliaged URAss Dust leakage -6 15 peFeeRt- Exempted from duct leakage testing if: ❑ 1. Duct system was documented to have been previously sealed and confirmed through HERS verification, or ❑ 2. Duct systems with less than 40 linear feet in unconditioned space, or ❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos ❑ 4. The system will not be Ducted (ie. Ductless Mini-Split System) (Also Exempt from Refrigerant Charge) ❑ 2. New HVAC System Required Forms: . Cut in or Changeout with new ducts: (all new CF-611 forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-22-HERS, and ducting =all new equipment) MECH-25-HERS CF-411 forms: MECH 20, and (for split systems) MECH-22, and MECH-25 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 . Includes replacing or installing all new ducting and/or outdoor condensing unit CF-611 forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS and/or indoor coil and/or furnace. No or some CF-411 forms: MECH-20 and (for split systems) MECH-25 equipment changed. For Split Systems: Duct leakage < 6 percent; RC, CCA 2 300 CFM/ton, TMAH For Packaged Units: Duct leakage < 6 percent O 4. New Ducting over 40 feet Required Forms: . Includes adding or replacing more than 40 CF-611 forms: MECH-04, MECH-2I-HERS linear feet of duct in unconditioned space. CF-4R forms: MECH-21 For split system or packaged units: Duct leakage < 15 percent ❑ EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos. Contractor (Documentation Author's /Responsible Designer's Declaration Statement) • I certify that this Certificate of Compliance documentation is accurate and complete. • I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of Compliance. • I certify that the energy features and performance specifications for the design Identified on this Certificate of Compliance conform to the requirements of Title 24, Parts 1 and 6 of the California Code of Regulations. • The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with the permit application. Name: Jim McEligot Signature: Jim McEligot Company: VENVEST BALLARD INC Date: Feb 27, 2012 Address: 2712 EAST LA CADENA DRIVE License: 878533 City/State/Zip: RIVERSIDE / CA / 92507 Phone: (951) 276-9744 Reg: 2.12-A0010176A-00000000-0000 Registration Date/Time: 7.01.2/02./27 14:59:�l HERS Provider: CalCERTS, inc. 2008 Residential Compliance Forms July 2010 .:. • ' BuQlding stSafety DivisJon .. ... :. :... :.; ; • . P.O. Box: iSO4,:78-495.Calfe,Tampfco la.Quinta, CA 92253 -':(760) 777-7012 Bu!lding Permit 'Application' and Tracking Sheet. 'Perinft# : ok ��' Project Address: ' c \� S ' (`� Owner's Name:. A P. Number. _ a 1 - �--� Address: S Legal Description: • Contractor.. C ; City, ST, Zip: a Telephone::. 'l Address: -� ` Project Description: City, ST, Zip: lr Telephone.. _•-`� � `� �� State Lie. # : �, Gj City Lie rb., 13W.,rDesigner. Ar., Designer Address: --• Cita', ST, lap: - Telephone: — Construction Type:. occupancy: State Lia #: _ Project type (circle one): New Add n. i Repair Demo Name of Contact Person: \`(� C� Sq. Ft.: #Stories: # Unitp: Telephone # of Contact Person: \>a �(Q_ -� Estimated Value of Project APPLICANT: DO NOT WRITE BELOW THIS. UNE !E Submittal Req'd Recd TRACIQNG PBRMIT.FEES Plan Seta Plan Check submitted Item Amount Structural Cates. Reviewed, ready for corrections Plan Check Deposit. . Trust Cale$. Called Contact Person Plan Check Balance Tide 24 Cates. Plans picked up Construction Flood plain plan Plans resubmitted.. Mechanical Grading plan 2'! Review, ready for corrections/issue Electrical Subeoxtaetor List Called Contact Person Plumbing Grant Deed Plans picked up SALL H.O.A. Approval Plans resubmitted Grading - IN HOUSE., Review; ready for correetionslissae Developer Impact Fee Planning Approval Called Contact Person A.LP.P- ° Pub. Wks. Appr - Date of permit issue School Fees 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.- ddress:45055 SPRING BROOK COURT, La Quinta;CA'92253 - • 45055 Enforcement Agency: 1. Permit Number: (System 1) A City of La Quinta 12-189 1 This installation certificate is required for compliance for alterations and additions in existing dwellings space conditioning systems -and duct systems. '' t 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,-, tc.) 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 y, " ❑ 2. Measured leakage to outside less than 10% of Fan Flow ' leakage ❑ 3. Reduce by 60% and c��nduct smoke and fix`all leaks w. ❑ 4. Fix all accessible leaks using smoke and HERS'rater verify' Note: (One of.•Options„ 1,,_2, or 3 must be attem pted, before-, utilizing OptionR4.)Y,. Determine nominal Fan'Flow using one of the following three calculation methods:ry ,, ( ✓ 1 �' m Cooling System method: Size of condenser.in Tons 3.5 x 400 " 1400 -CFM , - ✓ ❑ Heating system merthod: 21.7l_I x Output Capacity in.Thousands of Btu/hr = - . CFM J — ✓ ElMeasured,sy_stem airflow using:RA3.3 airflow'test procedures:• CFMti ,s, _1 Option'1•used then: '� Allowed leakage = Fan Flow 1400 x•0.15 = 210. CFM ' Actual Leakage`—, . 55' CFM :. .. 'i Pass'if Leakage Actual is less than Allowed Pass Fail Option 2 used then:' 2 Allowed leakage = Fan'Flow- x 0.10 = CFM: , Actual Leakage to outside•= I 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 F ((Leakage reduction _ / Initial leakage _J x 100% _ /0 Reduction ' Pass if % Reduction > 60% p Pass p Fail 4 Option 4 used then: .• • AEll accessible leaks repaired using smoke. HERS rater must verify (No sampling). No smoke E allowed to leak from system. Including ducts, plenums, air handler and door panel., ' Pass if all accessible leaks have been repaired using smoke Pass ❑ Fail * i Reg: 212-A0010176A-M2100001A-M21A Registration Date/Time: 2012/03/07 14:21:00• HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms 4 March 2010 ' t ' * i Reg: 212-A0010176A-M2100001A-M21A Registration Date/Time: 2012/03/07 14:21:00• HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms 4 March 2010 ' CERTIFICATE OF FIELD VERIFICATION &DIAGNOSTIC TESTING _"" CF-4R-MECH-21 Duct Leakage Test — Existing Duct System' - (Page 2 of 2) Site Address: - 45055 SPRING BROOK COURT, La Quinta CA 92253.' Enforcement Agency: Permit Number: (System 1) - . • City of La Quinta 12-189 , m Outside air (OA) ducts for C astral 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. t , • ' • Air.-..:_ © All supply and return register boots must beisealed to the drywall if;smoke test is' utilized forlcompliance — appliesAo,duct leakade compliance option 3 (leakage reduction by 60%) and option'41(fiz all accessible , leaks) described above: /� f r Y } - 0 New ducti,nst,.a�yllartionsyicannot utilize;building cavities asf'pl{enums for platform returns' m lieu of, %0? ® Mastic and draw bands must.be used -in combination with cloth backed rubber adhesive duct tape to seal leaks at all ,new duct connectiong . 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 whoperformed 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. b . The information reported on applicable sections of the Installation`Certificate(s) (CF -6R), signed and submitted by the person(s) _ responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF, -1R) approved by the enforcement agency. • ; • _ ' ^ , , - f A a Builder or Installer information as shown on the Installation Certificate (CF -6111) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) 'VENVEST BALLARD INC, ' Responsible Person's Name: -w License: Jim McEligot JCSLB 878533 HERS Provider Data Registry Information Sample Group #+ if applicable):, N A P P (• PP )� / tested/verified dwelling ❑ not-tested/verified dwelling in ' • • a HERS sample group HERS Rater Information .CaICERTS Certificate # CC1-1798633375 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: 3/2/2012 CC2004503 Reg: 212-A0010176AMM2100001A-M21A Registration Date/Time: 2012/03/07 14:21:00 ' HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms', March 2010 N, R Reg: 212-A0010176AMM2100001A-M21A Registration Date/Time: 2012/03/07 14:21:00 ' HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms', March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-25 . Refrigerant Charge Verification - Standard Measurement Procedure (Pagel of 5) Site Address: Enforcement Agency: Permit Number: 45055 SPRING BROOK COURT, La Quinta CA 92253" 1 City of La Quinta 127189 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 Supply and Return Plenums of Air Handler System Name or Identification/Tag System 1 ., y System Location or Area Served Whole House 1 0 Yes ❑ No 5/16 inch (8 mm) access hole upstream of evaporative coil in the return plenum and J- labeled according to Figure in Section RA3.2.2.2.2. - 2 ® Yes ❑ No 5/16 inch (8 mm) access hole downstream of evaporative coil in the supply plenum and labeled according to Figure in Section RA3.2.2.2.2. Yes to 1•and 2 is a pass. Enter Pass or Fail ✓ 0 Pass ,V ❑ Fail f STMS-' Senso_r onAhe,Evaporator Coil_ _�.� _�; ;._ ,,::.,�• ,; ,•. .� � , System Name'or Identification/Tag"] l `,�{ System 1 '--1 " -,l �:�' If ti V. # (' 11 r 3 ❑Yes I �,, p•No The sensor is factory' installed, orfiield installed according to.manufacturer's_ specifications, or islinstalled,by methods/specifications approved by.the Executive f i• : 1 ! Director. €, :ice.1 ar �#) j� :The sensor wire is termi ated.with a standard mini plug suitable for connection to•a f 4 p Yes , ❑ No digital thermometer. The sensor mini plug is to the'insfalling technician and the HERS rater without changing the airflow through the condenser coil 5 ❑ Yes •--- ❑ No When attached to a digital thermometer, the sensor provides an indication of the saturation temperature of the coil. Yes to 3_4, and 5 is a pass. Enter N/A if STMS are not ✓ ® N/A '- ✓ ❑ Pass ✓ ❑ Fail applicable. Otherwise enteV Pass or Fail ' (STMS - Sensor on the Condenser Coil , System Name or Identification/Tag System 1 • The sensor is factory installed, or field installed according to manufacturer's 6 ❑ Yes ❑ No specifications, or is installed by methods/specifications approved by the Executive Director. The sensor wire is terminated with a standard mini plug suitable for connection to a 7 ❑ Yes ❑ No digital thermometer. The sensor mini plug is accessible to the installing technician and the HERS rater without changing the airflow through the condenser coil 8 ❑Yes . p No When attached to a digital thermometer, the sensor provides an indication of the saturation temperature of the coil. k Yes to 6, 7, and 8 is a pass. Enter N/A if STMS are not applicable. Otherwise enter. Pass or Fail, - 0 N/A ✓ ❑ Pass ❑ Fail Standard Charge Measurement Procedure (for use if outdoor air dry-bulb is above 55°F) , Procedures for determining Refrigerant Charge using the Standard Charge Measurement Procedure are available in Reference Residential ' Appendix RA3.2. As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional form(s) for any additional systems in the dwelling as applicable. • The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure. The system must meet minimum airflow requirements as prerequisite for a valid refrigerant charge test. " • } If outdoor air dry-bulb is 55°F or below, the installer must use the Alternate Charge Measurement Procedure. Space Conditioning Systems I} ` System'Name or Identification/Tag System i� (must be re -calibrated monthly) A €`'�' ' t-';- f if ti r4' 11i ai ' T/ � -" 3/1/2012 t Standard Charge Measurement Procedure (for use if outdoor air dry-bulb is above 55°F) , Procedures for determining Refrigerant Charge using the Standard Charge Measurement Procedure are available in Reference Residential ' Appendix RA3.2. As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional form(s) for any additional systems in the dwelling as applicable. • The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure. The system must meet minimum airflow requirements as prerequisite for a valid refrigerant charge test. " • } If outdoor air dry-bulb is 55°F or below, the installer must use the Alternate Charge Measurement Procedure. Space Conditioning Systems I} ` System'Name or Identification/Tag System i� (must be re -calibrated monthly) A €`'�' ' t-';- f if ti r4' 11i ai ' T/ Date of Thermocouple Calibration + -" 3/1/2012 { r f System Location or+Area Served Whole House , , uh..�•w,''. =. .,, t , s r Outdoor Unit Serial # - �� .. 965060864 •. { r temperature (T K return, db) + ' Outdoor Unit Make - Comfortmaker Outdoor Unit Model ` 1 ACSO42 , Nominal Cooling Capacity Btu/hr _ '' 42000 ' ,t e of Verification `f.. �] rp, 3/2/2012 , Calibration of Diagnostic Instruments , r , Date of Refrigerant Gauge Calibration`�, 3/1/2012 (must be re -calibrated monthly) A €`'�' ' t-';- f if ti r4' 11i ai ' T/ Date of Thermocouple Calibration + -" 3/1/2012 must be r calibrated monthly) r f Supply'(evaporator leaving)'air dry-bulb ' _ • _ t IL _.'�" , uh..�•w,''. =. .,, temperature (T ) r_ supply, db . - s 4• ♦ . r 72'0 temperature (T K return, db) + ' i. 56.4 temperature (Treturn, wb) Calibration of Diagnostic Instruments , r , Date of Refrigerant Gauge Calibration`�, 3/1/2012 (must be re -calibrated monthly) A €`'�' ' t-';- f if ti r4' 11i ai ' T/ Date of Thermocouple Calibration + -" 3/1/2012 must be r calibrated monthly) r f Supply'(evaporator leaving)'air dry-bulb ' _ • _ t IL Measured Temperatures}(°F)., J/: System Name or Identification/Ta r 9: S •stem 1 Y a. •.. >--r• A €`'�' ' t-';- f if ti r4' 11i ai ' T/ ± r ..••:J 1 . 9.>�.1 r i'::- Supply'(evaporator leaving)'air dry-bulb ' _ • _ `51 ; " ..a _.'�" , uh..�•w,''. =. .,, temperature (T ) r_ supply, db . - s Return (evaporator entering) air dry-bulb,` 72'0 temperature (T K return, db) + ' Return (evaporator entering) air wet -bulb 56.4 temperature (Treturn, wb) Evaporator saturation temperature 34` ' (Tevaporator, sat) Y Condensor saturation temperature 80 , (Tcondensor, sat) y . Suction line temperature (Tsuction) ' 44 _ Liquid Line Temperature (Tliquid) +' 70 ' Condenser (entering) air dry-bulb ti 72 , temperature (Tcondenser, db) r ' Reg: 212-A0010176A-M2500001A-M25A.,Registration Date/Time:-2012/03/07 14:22:51 . HERS Provider: Ca10ERTS, Inc.' 2068 Residential Compliance Forms March 2010 y ` Minimum Airflow Requirement ' Temperature Split Method Calculations for. determining. Minimum Airflow Requirement for Refrigerant Charge, Verification. The temperature split method is specified in Reference Residential Appendix RA3.2. System Name or Identification/Tag System 1 • , , .' Calculate: Actual Temperature Split .= Treturn, 21.00 db - Tsupply, db Y Target Temperature Split from Table RA3.2-3 20.6 using Treturn, wb and Treturn, db , Calculate difference: Actual Temperature Split 0 4 k V ' Target Temperature Split = Passes if difference is between -4°F and +4°F or, upon remeasurement,. if between -4°F and PASS -100°F, - Enter Pass or Fail Note: Temperature Split Method Calculation is not necessary if actual Cooling Coil Airflow is verified using one of the airflow measurement procedures specified in Reference Residential Appendix RA3.3.Wa6tual 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) 4 System Name o Ide, ification/Tag ,y F • 1`'�- - S Calculated Minimum Airflow Requi ement (CFM) a�` • Measured'Airflowf;using RA3.3 proced�uyres (CFM) Passes if measured airflow is greater than or :' , ' ; ` equal to the calculated minimum airflows . - requirement."' - ''yq,• , .t .; 4L, . Enter Pass or Fail Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for fixed orifice metering device systems System Name or Identification/Tag • , , .' Calculate: Actual Superheat= Tsuction - Tevaporator, sat Y Target Superheat from Table RA3.2-2 using Treturn, wb and Tcondenser, db Calculate difference: t k V Actual Superheat - Target Superheat _ System'passes if difference is between -6°F and Enter Pass or Fail - i Reg: 212-A0010176A-M2500001A-M25A Registration Date/Time: 2012/03/07 14:22:51 .HERS Provider:-CalCERTS, Inc. 2008 Residential Compliance Forms March,2010 •A INSTALLATION CERTIFICATE CF-4R=MECW25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5) Site Address: [Enforcement Agency:, Permit Number: " 45055 SPRING BROOK COURT,,LaV,Quinta CA 92253 ' City of La Quinta _ 12=189 - 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.- ystems.'System SystemName or Identification/Tag ' System 1 ` �+ ° • }" Calculate: Actual Subcooling _ 10.0 Tcondenser, sat - Tliquid Target Subcooling specified by manufacturer 10 Calculate difference: 0 f ' ti • ` "• Actual Subcooling - Target Subcooling System passes if difference is between'" 4 -4°F and +4°F PASS (;;,7);. t i ` Enter Pass or,Fail _ r•+c.,�,� � 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 �I System 1 �+ ° • r , Calculate: Actual Superheat = + '10.0, Tsuction - Tevaporator, sat ' Enter allowable superheat range from +! i manufacturer's specifications (or use range 10 f ' ti • ` "• between 3°F and 26°F if manufacturer's specification is not_availeble) � System'passes if. actual superheat is'within0 allowable superheat range /, 'r- (;;,7);. �+ • F i ` Iyf`•PASS ' ,Enter Pass or:Fail r•+c.,�,� I i r " ,JJ ��+ sr ' � `_•-".sk".._. d {9 w �l "{. ^}�' .te ���1! - .. -try; r� r. "'•p i, S '-."�' � < d� «• - '� - _ �•^� :. � - ,`. a , ' • y. t, - � a �� Reg: 212-A0010176A-M2500001A-M25A.,Registration Date/Time: 2012/03/07'14:22:51 HERS Provider: Ca10ERTS,�IInc. 2008 Residential Compliance•Forms, March 2010 i•• ,. .. 4 i r " ,JJ ��+ sr ' � `_•-".sk".._. d {9 w �l "{. ^}�' .te ���1! - .. -try; r� r. "'•p i, S '-."�' � < d� «• - '� - _ �•^� :. � - ,`. a , ' • y. t, - � a �� Reg: 212-A0010176A-M2500001A-M25A.,Registration Date/Time: 2012/03/07'14:22:51 HERS Provider: Ca10ERTS,�IInc. 2008 Residential Compliance•Forms, March 2010 i•• INSTALLATION CERTIFICATE CF-4R-MECH-25 ' Refrigerant: Charge Verification - Standard Measurement Procedure ` (Page 5 of 5) +: Site Address:. + Enforcement Agency: Permit Number: 45055 SPRING BROOK COURT, La Quilita CA 92253 City of La Quinta 12-189 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 Fecalculated. System Name or Identification/Tag System 1 s r . Sample Group # if applicable)' N/A c ❑ not-tested/verified dwelling in' la HERS sample. group requirements. PASS 1 Responsible Rater's Name:, Responsible Rater's Signature: Enter Pass or Fail, INSTALLATION CERTIFICATE CF-4R-MECH-25 ' Refrigerant: Charge Verification - Standard Measurement Procedure ` (Page 5 of 5) +: Site Address:. + Enforcement Agency: Permit Number: 45055 SPRING BROOK COURT, La Quilita CA 92253 City of La Quinta 12-189 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 Fecalculated. System Name or Identification/Tag System 1 1878533 ' HERS Provider Data Registry Information Sample Group # if applicable)' N/A System meets all refrigerant charge and airflow ❑ not-tested/verified dwelling in' la HERS sample. group requirements. PASS 1 Responsible Rater's Name:, Responsible Rater's Signature: Enter Pass or Fail, Andrew Pulos Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 3/2/2012 CC2004503 y i t DECLARATION STATEMENTy t ' . 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, mate'rial, component, or manufactured device requiring HERS verification that is identified on this certificate (the installation) complies with the applicable requirements in Reference ResidentialAppendicesRA2 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 Certificate(s) of Compliance (CF -1R) approved by the enforcement agency. Builder or Installer information as shown on the Installation Certificate (CF -6111) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) , 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-CaICERTS Certificate # CC1-1798633375 HERS Rater Company Name: ;. Athens Air i Responsible Rater's Name:, Responsible Rater's Signature: Andrew Pulos Andrew Pulos Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 3/2/2012 CC2004503 . r Reg: 212-A0010176A-M2500001A-M25A Registration Date/Time: 2012/03/07 14:22:51 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms t March 2010 INSTALLATION CERTIFICATE '. CF-6R-MECH-04 Space Conditioning, Systems, Ducts and Fans (Page 1 of: 2) t Enforcement Agency:. Permit Number: ` (System 1) City of La Quint a , 12-189 INSTALLATION CERTIFICATE '. CF-6R-MECH-04 Space Conditioning, Systems, Ducts and Fans (Page 1 of: 2) Site Address:. ' 45055 SPRING BROOK COURT, La Quinta CA 92253•. Enforcement Agency:. Permit Number: ` (System 1) City of La Quint a , 12-189 Space Conditioning Systems Heating Equipment - • Duct Efficiency Location} ' Equip (AFUE, (attic, Type ' ARI # of etc.)l, 3 'crawl- Heating Heating r (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 Amana - Furnace AMVC80604BX 1 80 AFUE Attic 48 60 kl3tu N I Cooling Equipment ; ` -•y; M ' Efficiency Duct Equip,� to, , ' (SEER Location a. and EER) (attic, Type. , (package " - «r 'ARI # of 1, 3 crawl- 1 Cooling Cooling. ' heat 'CEC Certified Mfr. Name Reference Identical (>=CF -1R space, Duct Load Capacity - Pump) and Model Numbers Number2 Systems value)4. etc.) R -value (kBtu/hr) (kBtu/hr) • .. < �` �''.k`?`'... �1. :ir".P'�•-.,�wr .J;,..,�- �"'�. ..� • ""-'1 i"-' �:,^. is�'-:'•` 3 �""�. �i �"•P`"`iE"'r' F , �, / ;' .. '� .. �C(� Imo'. � ,� � , � � �; . ,) •.`, , ` ' fr; ° � r _I .,�, �,;, u . w- 7 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 numbenat http://www.aridirectory.orglaiilzicphp# 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 CF71R, CF -IR -AA or CF -IR -ALT k ALL BOXES MUST BE CHECKED TO BEA VALID FORM •" 65 §110-§113: HVAC equipment is certified by the California Energy Commission.. m §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). . 13 §150(j)2: Pipe insulation for cooling system refrigerant suction, chilled water and brine lines meets minimum requirements of T6ble'150-13 and includes a vapor retardant or is enclosed entirely in + conditioned space.' i ;M •t Reg: 212-A0010176A-M0400001A'-0000 Registration Date/Time: 2012/03/07 14:16:44 HERS Provider:`•Ca10ERTS, Inc. 2008 Residential Compliance Forms August 2009 • 4. INSTALLATION CERTIFICATE ' CF-6R-MECH-04 Space Conditioning Systems, Ducts and Fans .. .(Page 2 of 2) Site Address: t` 45055 SPRING BROOK COURT, La..Quinta CA 92253 Enforcement Agency:; Permit Number: (System 1) - City of La Quinta. 12 -189 - e, Ducts and'Fans r ` . §150(m): Duct and Fans 2 1. All air -distribution system''ducts and plenums installed, sealed and insulated to meet the r �. 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 t 0 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. ` t 0 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'. 0 7. Exhaust fan systems have back draft or automatic dampers. "y , 0 8. Gravity ventilating systems serving conditioned space have either automatic or readily accessible, manually operateclAampers: 0 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 ,, 0 10. Flexible,ducts cannot have porous, inner cores.- q DECLARATION STATEMENT 's • 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 -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. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) - ti 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• , 2/20/2012, 4 ` Reg: 212-A0010176A-M0400001A-0000 ,-Registration Date/Time: 2012/03/07 14:16:44-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: - 45055 SPRING BROOK COURT, La' Quinta CA 92253 Enforcement Agency: Permit Number: (System 1) City.of,La Quinta 12-189 Enter the Duct System Name or Identification/Tag: System 1 4 ' 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 , • is • • Enter the Duct System Name or Identification/Tag: System 1 4 ' 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 Options 1, 2 3 mus utilizing, Option 4..)-•-a. of or .be attempted _before _,,,,,� . _ Determine nominal Fan Flow using one of the''following three' calculation methods.' 'system method: 13.5 ✓ El Cooling Size of condenser in Tons x 400:= 1400 CFM � ,� 4 ., -,;C1 z I in, housands = Heating system method Zl: Output Capditty of B hr CFMAt ' ✓O Measured _system aAxirflow using� RA3.3 airflov� st"procedure : E�, .;7 , 't •i �f rz _FCFM, Option 1 used then: _ Allowed leakage = Fan Airflow 1400 x`0.15Y= 210 CFM 014 1 Actual Leaka e`= 80 CFM, g ' • 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.= I 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 usirig'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 usingL'smoke test. HERS rater must verify (No Sampling). ' ' Pass if all accessible leaks have been repaired using smoke Pass Fail . t Reg: 212-A0010176A-M2100001A-0000 Registration Date/Time: 2012/03/07 14:17:23' HERS Provider: CaICERTS, Inc. 2008 Residential Compliance Forms ` March 2010 Y INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS Duct Leakage Test - Existing Duct System '(Page 2 of 2) Site Address: 45055 SPRING BROOK -COURT, Ld Quinta CA 92253 - , Enforcement Agency: 1 Permit Number: (System 1)City of La Quinta J2-189., © 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,,-* V 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. m All supply,.and-return register boots*must.be�seal�ed to the'drywall'if smoke test is utilized for/compliance ' - applies�to duct leakage compliance"option 3 (leakage reduction by6�0%) and option 4�(fik all accessible leaks) described above. ® New ductfiinstallations s o cannot utilize building cavities asiplenumr platform returns In Iieu duct �. ,,.ir wr D Mastic and draw -bands must'lie used in combination;with cloth backed rubber: adhesive duct tape to seal , leaksat all new duct connections •,i - DECLARATION STATEMENT • I certify under penalty of perjury, under the laws of the State 8f:Calif6rnia, the information provided on this form is true and correct: c • 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 f 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. 1 ' 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: i Ruth Debrick Ruth bebrick © 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,,-* V 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. m All supply,.and-return register boots*must.be�seal�ed to the'drywall'if smoke test is utilized for/compliance ' - applies�to duct leakage compliance"option 3 (leakage reduction by6�0%) and option 4�(fik all accessible leaks) described above. ® New ductfiinstallations s o cannot utilize building cavities asiplenumr platform returns In Iieu duct �. ,,.ir wr D Mastic and draw -bands must'lie used in combination;with cloth backed rubber: adhesive duct tape to seal , leaksat all new duct connections •,i - DECLARATION STATEMENT • I certify under penalty of perjury, under the laws of the State 8f:Calif6rnia, the information provided on this form is true and correct: c • 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 f 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. 1 ' 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 Licenser Date Signed: Position With Company (Title): 878533 2/20/2012' Is this installation monitored by a Third Party Quality i Name of TPQCP (if applicable): ••. Control Program,(TPQCP)? ❑ Yes ❑ No � r -Reg: 212-A0010176A-M2100001A-0000 ;Registration Date/Time: 2012/03/07 14:17:23 HERS -Provider: CaICERTS, Inc.' +• 2008 Residential Compliance Forms F i * March 2010 r r � r -Reg: 212-A0010176A-M2100001A-0000 ;Registration Date/Time: 2012/03/07 14:17:23 HERS -Provider: CaICERTS, Inc.' +• 2008 Residential Compliance Forms F i * March 2010 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 Supply and,Return Plenums of Air Handler System Name or Identification/Tag _ System 1 System Location or Area Served Whole House 1 .0 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 0 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 Faill ✓ 0 Pass ✓ ❑ Fail (STMS - Sensor.on,the Evaporator Coil System Na.me•or Identification/Tag j f. oefj System T TT 3 r7 ❑ Yes ❑ Nod,, The sensor is factory installed, or,field installed according to manufacturer's ;^ specifications, or isoinstalled by methods/specifications approved by the Executive"'• ` z Director. 4 ❑ Yes yr ( ' p No c" The sensor wiFe is terminated with a standard'mini plug suitable for connection to a( digital thermometer.`The sensor mini plug is accessible to the insfalling fec[Nciar - _ and the HERS rater without changing the airflow through the condenser coil Yes ❑ No The sensor measures the saturation temperature of the coil within 1.3 degrees F 3;4,and 5 is a'pass. Enter N/A. if STMS are not Ealt!,,able. V ® N/A ✓ ❑ Pass ✓ ❑ Fail Otherwise enter Pass.or;Fail STMS - Sensor on the Condenser Coil System Name or Identification/Tag ; System 1 The sensor is factory installed,or field installed according to manufacturer's 6 ❑ Yes ❑ No specifications; or is installed by methods/specifications approved by the Executive Director. The sensor wire is terminated with a standard mini plug suitable for connection to a 7 ❑ Yes ❑ No digital thermometer. The sensor mini plug is accessible to the installing technician and the HERS rater without changing the airflow through the condenser coil 8 ❑ Yes ❑ No The sensor measures the saturation temperature of the coil within 1.3 degrees F Yes to 6, 7, and 8 is a pass. Enter N/A if STMS are not ✓ p N/A ✓ ❑ Pass ✓ ❑ Fail applicable. Otherwise enter Pass or Fail Reg: 212-A0010176A-M2500001A-0000 Registration Date/Time: 2012/03/07 14:19:23 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification = Standard Measurement Procedure (Page 2.of 5) Site Address: Enforcement Agency: Permit Number: 45055 SPRING BROOK COURT, La Quinta CA 92253 " 'City of La'Quinta 12-189 Standard Charge Measurement Procedure (for use if outdoor air dry-bulb is above 55°F) +• Procedures for determining Refrigerant Charge using the Standard Charge Measurement Procedure are available in Reference Residential Appendix RA3.2. As many as 4 systems in the dwelling can be documented for compliance using this form: Attach an additional form(s) for any additional systems in the dwelling as applicable. . 1 1_ + The system should be installed and charged in accordance with the manufacturer's specif=ications before starting this procedure. The system must meet minimum airflow requirements as prerequisite for a valid refrigerant charge test. 1,1 .. • If outdoor air dry-bulb is 55°F or, below, the installer must use the Alternate Charge Measurement Procedure. ), Space Conditioning Systems System. Name or Identification/Tag ' �' 'System 1 (must be re -calibrated monthly) - —o MJ��y�� /7 System Location or Area Served Whole House f, 2/1/2012 _--% 4f- f (must be, monthly) - Outdoor Unit Serial #. •. 1_965060864 „ �� _, }" Outdoor Unit Make Comfortmaker f Outdoor Unit Model ACSO42 ', t Nominal Cooling Capacity Btu/hr 42000 'f Return (evaporator entering) air wet -bulb 56.2 Date of Verification 2/20/2012 +•. • :. . Evaporator, saturation temperature 33 . , Gaubration or Diagnostic Instruments -+ Date of Refrigerant Gauge Calibration 2/1/2012 (must be re -calibrated monthly) .,X �'....7, ��' ya —o MJ��y�� /7 ' Aro . ir% Date of Th rmocouple Calibration 77 ; f, 2/1/2012 _--% 4f- f (must be, monthly) Supply,(evaporator leaving) air dry-bulb',50 3 Measured Temperatures'`('F)_ �. i ' u =j ,. 'tc'" _ f ; `L \: #; _- I System Name, or Identification/Tag jAt► System 1 ••/ice L ,_,. .,X �'....7, ��' ya —o MJ��y�� /7 ' Aro . ir% Supply,(evaporator leaving) air dry-bulb',50 _ *� �� _, }" temperature (Tsupply, db) �. i- f Return (evaporator entering) air dry, -bulb . _.I 71.2 temperature (Treturn, db,) Return (evaporator entering) air wet -bulb 56.2 temperature (Treturn, wb) \ I Evaporator, saturation temperature 33 (Tevaporator, sat) . ! Condensor saturation temperature s0 (Tcondensor, sat) Suction line temperature (Tsuction) �' c 43 Liquid Line Temperature (Tliquid) t `71 - , Condenser (entering) air dry-bulb 72 temperature (Tcondenser, db) r' Ft y �. Reg: 212-A0010176A-M2500001A=0000 Registration Date/Time: 2012/03/07 14:19:23 HERS Provider:�Ca10ERTS, Inc_.' 2008 Residential Compliance.Forms f 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: ; 45055 SPRING BROOK COURT, La Quinta CA 92253 City of La Quinta 12-189 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 r . Calculate: Actual Temperature Split = Treturn, 21,20 db - Tsupply, db t• Target Temperature Split from Table RA3:2-3 - 20.1 using Treturn, wb and Treturn, db Calculate difference: Actual Temperature Split - - Target Temperature Split Passes if difference is between -3°F and +3°F or, ,. upon remeasurement, if between -3°F and PASS -1000F , Enter Pass or Fail , t ' Note: Temperature Split Method Calculation is not necessary if actual Cooling Coil Airflow is verified using one of the airflow measurement procedures specified in Reference Residential Appendix RA3.3. If actual cooling coil airflow is measured, the value must be equal to or greater than the Calculated Minimum Airflow Requirement in the table below. Calculated Minimum Airflow Requirement (CFM)== Nominal Cooling Capacity (ton) X 300 (cfm/ton) System Name o Ide t ication/Tag Calculated Minim(CFM um Airflgw Requi ement )• 'tel-'' r� Measured Airflow using RP 3.3 procedures (CFM%1 " 6W '. `�• Vii.. -.r+... *.. r. - ,r..:+=^• -3+ _--•,«!`.. r, !°! 4 ; 4t Passes if measured airflow is greater than or,, , equal to the calculated minimum airflow, requirement.' I '• ,'1_1 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 r 'P r Calculate: Actual Superheat =• t• Tsuction - Tevaporator, sat Target Superheat from Table RA3.2-2 using Treturn, wb and Tcondenser, db - Calculate difference: Actual Superheat - Target Superheat System passes if difference is between -5°F and - +50F Enter Pass'or Fail t ' Reg: 212-A0010176A-M2500001A-0000 Registration Date/Time: 2012/03/07 14:19:23 -,HERS Provider: CalCERTS,"Inc. 2008 Residential Compliance Forms August -2009 'P r Reg: 212-A0010176A-M2500001A-0000 Registration Date/Time: 2012/03/07 14:19:23 -,HERS Provider: CalCERTS,"Inc. 2008 Residential Compliance Forms August -2009 INSTALLATION CERTIFICATE r• CF-611-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5) Site Address:. Enforcement Agency:' Permit Number: 45055 SPRING BROOK COURT, La'Quinta CA 92253 City. of La Quinta 12-189 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 • J • Calculate: Actual Subcooling = ( g " !condenser, sat.- Tliquid r - Target Subcooling specified by manufacturer 10 Calculate difference:. _1 w Actual Subcooling - Target Subcooling;, System passes if difference is between -3°F and +30F•= PASS , Enter Pass or Fail " Metering Device Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag fi n I _ • J • 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 fi n System 1 Calculate: Actual Superheat = , 10.0 Tsuction - Tevaporator, sat . Enter, allowable superheat range from manufacturer's specifications (or use range 10'' between 4°F and 25°F if manufacturer's specification is not available) System passes,if actual'superheat is=withinRtfi_e allowable superheat range' PASS it Enter Pass'or,Fail " � „ �`��`- l ,}��[+ (.:� �. .. `, =�� - `, Lr - ..l • .�}� ,l +. •./-�•J"/"i. tom".. •�.i•w ♦ • . . - �ai..-�' X11! �f-j'�•41 f! r i� r- t.�.V�T"w", s! k' ,q, Reg: 212-A0010176A-M2500001A-0000 Registration'Date/Time: 2012/03/07 14:19:23. HERS'Provider: Ca10ERTS, Inc. 2008 Residential -Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS , Refrigerant Charge Verification- Standard Measurement Procedure (Page 5 of 5) Site Address: Enforcement Agency: Permit Number: 45055 SPRING BROOK COURT, La.Quinta CA 92253 City of La,Quinta 12-189 ' Standard Charge Measurement Summary: System shall pass both refrigerant, charge criteria, metering device criteria (if.applicable), and minimum cooling coil airflow criteria based on measurementstaken 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: 87SS33 , > position With Company (Title): i System meets all refrigerant charge and airflow Name of TPQCP (if applicable): i { 1 + requirements. .. r PASS +, . ,Enter Pass or Fail ' M 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. y , • 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.. F . 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: 87SS33 , Date Signed:- 2/20/2012 position With Company (Title): i Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): i Control Program (TPQCP)? ❑ Yes ❑ No 1 + .Reg: 212-A0010176A-M2500001A-0000 Registration Date/Time: 2012/03/07 14:19:23 HERS Provider: CalCERTS,•Inc.- ' - 2008 Residential Compliance Forms August 2009