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14-0717 (MECH)I P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 14-00000717 Property Address: 54163 SHOAL APN: 775 -041 -013 - Application description: MECHANICAL Property Zoning: LOW DENSITY Application valuation: 18078 Applicant: Tdy BUILDING & SAFETY DEPARTMENT .BUILDING PERMIT Owner: CREEK DARLENE VARZAK - 54163 SHOAL CREEK LA QUINTA, CA 92253 RESIDENTIAL (760)771-1629 Architect or Engineer: UcENSED CON ACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licen oder provisions of Chapter 9 ym encing with - Section 7000) of Division 3 of the Business and s nals Cod nd my Lic epi in full force and effect. Licen lass:: C20 Lic No.: 37 Date: 10 Contractor: I hereby affirm under penalty of perjury t I am exempt AQ=jbe<ontractor's State License Law for the following reason (Sec. 7031 .5, Businsg and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500):: 1 _) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). (_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). ( ) I am exempt under Sec. , B.&P.C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.)• Lender's Name: _ Lender's Address: LQPER.MiT Contractor: PALM DESERT AIR COND CO INC 42081 BEACON HILL PALM DESERT, CA 92211 (760)346-0677 Lic. No.: 374937 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 5/30/14 E AY 3 00 20114 D CITY OF LA4VkNTA t FINANCE CEPT. 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 A,___'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 MID CENTURY . Policy Number A09454905-12 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 becomeject to the workers' compensation laws of California, and agree that, if I should become su ct to the workers' compensation provisions Qif Section �/ 3700 of the Labor Code a or ith comply with those provis' 4ate: App icar nt: WARNING: FAILURE TO SECURE ERS' COMPENSA COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CR AL PENALTIES AN 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 Quinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state th inform rs correct. I agree to comply city and county ordinances and state laws relatirig [o building onstr i , and hereby authorize re atives of this c ty to enter up_ on th bove-mentioned property r in ec ' n purposes. Date: _ Signature (Applicant or Agentl: El Application Number Permit Additional desc . Permit Fee . . . . Issue Date . . . . Expiration Date . . . . . . 14-00000717 MECHANICAL 2013 143.00 Plan Check Fee . Valuation . . . 11/26/14 Qty Unit Charge Per Extension 2.00 35.7500 EA MECH FURNACE 71.50 2.00 35.7500 EA MECH CONDENSER/COMP 71.50 ---------------------------------------------------------------------------- Special Notes and Comments HVAC CHANGE OUT - 16SEER/80AFUE, REPLACE (2) HVAC SPLIT SYSTEMS [2008 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2013 CALIFORNIA BUILDING CODES. ---------------------------------------------------------------------------- Other Fees . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 PERMIT ISSUANCE M/P/E 90.57 PLAN CHECK, MECHANICAL 95.32 Fee summary Charged Paid Credited Due Permit Fee Total 143.00 .00 .00 143.00 Plan Check Total .00 .00 .00 .00 Other Fee Total 186.89 .00 .00 186.89 Grand Total 329.89 .00 .00 329.89 LQPERMIT GEN afWe DESERT — - P.O. Box 1504.78-495 Calle Tampico, • La Quinta, California 92211 Tel: (760) 777-7012 • Fax: (760) 777-7112 ' Website: www.La-Quinta.Org • Email: Building@La-Quinta.Org ov,t+w°� Bin #: I Permit #:/1/-7/7 1 Building Permit Application & Tracking Sheet Project Address: 54163 SHOAL CREEK Owner's Name: VARZAK, DARLENE A.P. Number. Address: 54163 SHOAL CREEK Legal Description: City, State, Zip: LA QUINTA, CA 92253 Contractor: Palm Desert Air Conditioning & Heating Company Telephone: (760) 771-1629 Address: 42-081 Beacon Hill ' Project Description: City, State, Zip: Palm Desert, CA 92211 REPLACE (2) AIR CONDITIONING SPLIT SYSTEMS. Telephone No.: (760) 346-0677 ' State: Lic. #: 374937 City Lic. #: 100886 Arch./Engr./Designer: Address: City, State, Zip: Telephone No.: Construction Type: Occupancy: State: Lic. #: Project Type: 0 New • ® Add'n • 0 Alter • 0 Repair • 0 Demo Name of Contact Person: KARL BROWN Sq. Ft.. # Stories: # Units: Contact Telephone No.: (760) 346-0677 Estimated Value of Project: $18,078.00 APPLICANT: DO NOT WRITE BELOW THIS LINE Submittal Req'd Recd Tracking Permit Fee's Plan Sets Plan Check Submitted Item ' Amount Structural Calcs. Reviewed, Ready for Corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Tide 24 Calrs. Plans Picked Up Construction Flood Plain Plan Plans Resubmitted Mechanical Grading Plan 2nd Review, Ready for Corrections Electrical Subcontractor List Called Contact Person Plumbing Grant Deed Plans Picked Up S.M.I. H.O.A. Approval Plans Resubmitted Grading IN HOUSE V Review, Ready for Corrections Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Works Appel Date of Permit Issue School Fees Total Permit Fee's Az Simplified Prescriptive Certificate of Compliance: 2008 Residential HVACAlterations CF -IR -ALT -HVAC Climate Zones 10 - 15 'Site Address: Enforcement Agency: Date: mit #: 54-163 Shoal Creek System 1 La Quinta, CA 92253 City of La Quinta May 30, 201.4 � - Dud insulation Conditioned Floor Equipment Type1 List Minimum Efficiency2 requirement Area Thermostat ❑ Package Unit ® Furnace ® AFUE 80% ❑ COP ❑ R 6 (CZ 10-13) Served by system ® Setback ® Indoor Coil ® SEER 16.0 ❑ HSPF' [I R gCZ 14-15) ( 1200 sf i if not already present, must be ® Condensing Unit ❑ EER ❑ Resistance installed) ❑ Other I I I . 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 CF -611 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 -6R shall also be on site for final inspection. ® 1. HVAC Changeout Required Forms: . All HVAC Equipment CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS replaced CF -411 forms: MECH-21 and (for split systems) MECH-25 . Condenser Coil and /or . Indoor Coil and /or CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS . Furnace CF -4R forms: MECH-21 and (for split systems) MECH-25 For Split Systems: Duct leakage < 15 percent; RC, CCA <_ 300 CFM/ton (Minimum Air Flow Requirement), TMAH For Packaged Units- leakage 4 19 PeFGeRt- Exempted from duct leakage testing if: ❑ 1. Duct system was documented to have been previously sealed and confirmed through HERS verification, or [12. 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) 112. New HVAC System Required Forms: . Cut in or Changeout with new ducts - '(all new - ' _ ' _ `, " 'r 's ' 'rn CF -6R forms: ,MECH 04,; -MECH-20 HERS, and (fog. split systems) MECH`22-HERS, and '"�" ''' ' ducting and all new MECH-25-HERS ` CF-4R'formsS MECH-20, and.(for split systems),MECH-22,:and MECH 25,!.h equipment) 'W"., -.. , For Split,Systems: Duct leakage,< 6 percent; RC, CCA 2: 350 CFM/ton; FWD, TMAH,,SS, and either_HSPP or. PSPP. For Packaged Units sDuct leakage •< 6 percent;, ,,;� , <*1 .'_ d�' K_ .k`+ii "• rti. kms: c< tory +z .: ❑ 3. New Ducts with/or without'` `' ="'"" Required Forms: Replacement . Includes replacing or installing all new ducting and/or outdoor condensing unit CF76R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS and/or indoor coil and/or furnace. No or, some CF -4R forms: MECH-20 and (for split systems) MECH-25 equipment changed. For Split Systems: Duct leakage < 6 percent; RC, CCA >_ 300 CFM/ton, TMAH For Packaged Units: Duct leakage < 6 percent ❑ 4. New Ducting over 40 feet Required Forms: . Includes adding or replacing more than 40 CF -6R forms: MECH-04, MECH-2I-HERS linear feet of duct in unconditioned space. CF -4R forms: MECH-21 For split system or packaged units: Duct leakage < 15 percent ❑ EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos. Contractor (Documentation Author's /Responsible Designer's Declaration Statement) . I certify that this Certificate of Compliance documentation is accurate and complete. . I am eligible under Division 3 of the Califomia 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: Karl Brown Signature: Karl Brown Company: PALM DESERT AIR CONDITIONING CO INC Date: May 30, 2014 Address: 42-081 BEACON HILL License: 374937 City/State/Zip: PALM DESERT/ CA / 92211 Phone: (760) 346-0677 Reg: 214-A0038948A-000000000-0000 Registration Date/Time:.2014/05/30 09:24:55 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms;. July 2010 Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-lR-ALT-HVAC Climate Zones 10 - 15 Site Address: Enforcement Agency: Date: Permit #: 54-163 Shoal Creek System 2 La Quinta, CA 92253 City of La Quinta May 30, 2014IN-7/7 Duct insulation Conditioned Floor Equipment Typei List Minimum Efficiency2 requirement • Area Thermostat ❑ Package Unit ® Furnace ® AFUE 80% ❑ COP [I R 6 i� 10-13) Served by system ® Setback ® Indoor Coil ® SEER 16.0 ❑ HSPF ❑ R 8 (CZ 14-15) 1200 sf If not already present, must be ® Condensing Unit ❑ EER ❑ Resistance installed) ❑ Other 1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF-IR-ALT-HVAC for each system. 2. Minimum Equipment Efficiencies: 13 SEER, 78% AFUE, 7.7HSPF for typical residential systems. HERS VERIFICATION SUMMARY Listed below are FOUR HVAC alteration Options. The installer decides what work is being done and picks one of the appropriate Options. Each Option lists the HERS measures that must be conducted. A copy of the forms shall• be left on site for final inspection and a copy given to the homeowner. At final, the inspector verifies that the work listed on this form was in fact the work completed by the installer. The inspector also verifies that each appropriate CF-6R and registered CF-4R forms (no hand filled CF-4Rs allowed) are filled out and signed. Beginning October 1, 2010, a registered copy of the CF-111 and CF-611 shall also be on site for final inspection. ® 1. HVAC Changeout Required Forms: . All HVAC Equipment CF-6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS replaced CF-4R forms: MECH=21 and (for split systems)-MECH-25 . Condenser Coil and /or . Indoor Coil and /or CF-6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS . Furnace CF-4R forms: MECH-21 and (for split systems) MECH-25 For Split Systems: Duct leakage < 15 percent; RC, CCA <_ 300 CFM/ton (Minimum Air Flow Requirement), TMAH Exempted from duct leakage testing if: [11. 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 orECh,angeout with new ducts: (all'new - - k.�.�- .. : .�- CF-6R forms:;MECH-04; MECH=20-HERS, and (for:split systems) MECH-22-HERS, and ducting and all new MECHa25LHERS ,n�• , <;,5 CF 4R forms:MECH-20, and f, r slit system,, s)d!MECH ` -22, fanG d.MECH-t2" o (Ap. equipment) :F _ :.• a.,,• For Split Systems:, Duct leakage 2 6'percent; RC, CCA > 350 CFM/ton, FWD, TMAH; STMS, and either HSPP or PS_PP ,Y'�:>. s For Packaged Units:-Duct leakager< 6,percent ❑ 3. New Ducts with/or without","; Required Forms: Replacement -:InclUdes"r`eplacing`or-i'nstalling'all`-new------_ ducting.and/or outdoor condensing unit CF-6R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS and/or indoor coil and/or furnace:.No or some CF-4R forms: MECH-20 and (for split systems) MECH-25 equipment changed. For Split Systems: Duct leakage < 6 percent; RC, CCA->_ 300 CFM/ton, TMAH For Packaged Units: Duct leakage < 6 percent ❑ 4. New Ducting over 40 feet - Required Forms: " . Includes adding or replacing more than 40 CF-6R forms: MECH=04, MECH-2I-HERS linear feet of duct in unconditioned space. CF-4R forms: MECH-21 For split system or packaged units: Duct leakage < 15 percent ❑ EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos. Contractor (Documentation Author's /Responsible Designer's Declaration Statement) . I certify that this Certificate of Compliance documentation is accurate and complete. . I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of Compliance. . I certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24, Parts 1 and 6 of the California Code of Regulations. . The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with the permit application. Name: Karl Brown, Signature: Karl Brown Company: PALM DESERT AIR CONDITIONING CO INC r Date: May 30, 2014 Address: 42-081 BEACON HILL License: 374937 City/State/Zip: PALM DESERT / CA / 92211 Phone: (760) 346-0677 Reg: 214-A0038949A-000000000-0000 Registration Date/Time: 2014/05/30 09:27:51' HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms. July 2010 INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS Duct Leakage Test — Existing Duct System (Page i of 2) Site Address: 54-163 Shoal Creek System 2, La Quinta CA 92253 Enforcement Agency: City of La Quinta Permit Nu ber: `7/-7 (System 1) 4. Fix all accessible leaks using smoke and HERS rater verify /.o Enter the Duct System Name or Identification/Tag: System 1 Enter the Duct System Location or Area Served: Whole House Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the dwelling. This installation certificate is required for compliance for alterations and additions in existing dwellings to space conditioning systems and duct systems. Note: For existing dwellings, a completely new or replacement duct system can also include existing parts of the original duct system (e.g., register boots, air handler, coil, plenums, etc.) if those parts are accessible and they can be sealed. For a completely new or replacement duct system installed in an existing dwelling, use the Installation Certificate titled 'Duct Leakage Test - Completely New or Replacement Duct System. " Duct Leakaae Diaanostic Test - existing duct system Select one compliance method from the following four choices. ® 1. Measured leakage less than 15% of fan Flow i7 2. Measured leakage to outside less than 10% of Fan Flow 17 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.) Determine nominal Fan Flow using one of. the. following three calculation methods. ✓ ® Cooling system method: Size of condenser in Tons 3. x 400 = 1200 CFM." ✓ ❑ Heating system method: 21.7 x Output Capacity in Thousands of Btu/hr = _ CFM ✓ 0 Measured system airflow using RA3.3 airflow test. procedures: CFM Option 1 used then: 1 Allowed leakage = Fan Airflow 1200 x 0.15 = 180 CFM Actual Leakage = 130 CFM 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 = _ CFM Pass if Actual leakage to outside is less than Allowed leakag ❑ Pass E3 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 17 Fail Reg: 214-A0038949A-M2100001A-0000 Registration Date/Time: 2014/05/30 09:56:42 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS Duct Leakage Test - Existing Duct System (Page 2 of 2) Site Address: 54-163 Shoal Creek System 2, La Quinta CA 92253 Enforcement Agency: Permit Number: (System 1) City of La Quinta Date Signed: 4/30/2014 ® 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. ,ter.' �',••..j � •' �, w - -4., -_.. „.-.: ; .Y , cn...,,�«„y�.�, , r, ® All supply and return register 66ots�must be sealed to the drywall if�_smoke test;is,utlllzed for,_compliance - applies!to duct leakage compliance"option 3 (leakage'red uction by 60%) and-066n,4(fix all accessible leaks) described above. -� x A ,"�.:`�;w � a � ,� _• ® New duct installations cannot utilize building cavities as plenums or platform returns in lieu of ducts. ® Mastic and'draw bands must be used in combination with cloth backed rubber adhesive -duct tape to seal leaks at all .new duct connections - DECLARATION STATEMENT • I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. • I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized representative of the person responsible for construction (responsible person). • I certify that the installed features, materials, components, or manufactured devices identified on this certificate (the installation) conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the enforcement agency. • I understand that a HERS rater will check the installation to verify compliance, and that that if such checking identifies defects, I am required to take corrective action at my expense. I understand that Energy Commission and HERS provider representatives will also perform quality assurance checking of installations, including those approved as part of a sample group but not checked by a HERS rater, and if those installations fail to meet the requirements of such quality assurance checking, the required corrective action and additional checking/testing of other installations in that HERS sample group will be performed at my expense. . I reviewed a copy of the Certificate of Compliance (CF -1R) form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF -111 that apply to the installation have been met. • I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. I will ensure that all Installation Certificates will come from a HERS provider data registry for multiple orientation alternatives, and beginning October 1, 2010, for all low-rise residential buildings. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) Palm Desert Air Conditioning Co • Responsible Person's Name: Responsible Person's Signature: Karl Brown Karl Brown CSLB License: 374937 Date Signed: 4/30/2014 position With Company (Title): Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? ❑ Yes ❑ No Reg: 214-A0038949A-M2100001A-0000 Registration Date/Time: 2014/05/30 09:56:42 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 .4 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page i of 6) Site Address: Enforcement Agency: Permit Number: 54-163 Shoal Creek System 2, La Quinta CA 92253 City of La Quinta 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, unless the TMAH Compliance Option is chosen. STMS are only required for completely new or replacement space -conditioning systems that utilize prescriptive compliance method. TMAH - Access Holes in SUDDIv and Return Plenums of Air Handler System Name or Identification/Tag System 1 System Location or Area Served Whole House 5/16 inch (8 mm) access hole 1 upstream of evaporative coil in the ® Yes ❑ Yes ❑ Yes ❑ Yes return plenum and labeled according ❑ No ❑ No ❑ No ❑ No to Figure in _Section RA3.2.2.2.2. Return side of the duct system is- sla la located entirely within conditioned ❑ Yes' ❑ Yes ❑ Yes ❑ Yes space and return airflow temperature ❑ No' ❑'No ❑ No ❑ No to be measured at the return grille. 5/16 inch (8 mm) accessbole ' 2 downstream of evaporative coil in the ®"Yes ` " 0 Yes ❑ Yes O Yes supply plenum and labeled according ❑ No ❑ No ❑ No ❑ No to Figure in Section RA3.2.2.2.2. The TMAH "Compliance Option should be checked only if it is physically impossible to drill the TMAH as required by Section RA3.2.2.2.2. Using this Compliance Option requires the HVAC installer to annotate on the HERS Provider's data registry an explanation as to why the TMAH cannot be installed on the system, and photographs of the equipment on which the TMAH cannot be installed. Use of this Compliance Option also requires minimum airflow verification through the direct measurement of airflow per RA3.3 For more information see htto://www.energy.ca.gov/title24/2008standards/special case appliance/ TMAH Compliance Option ❑ ❑ ❑ ❑ Yes to 1 and 2, or Yes to la and 2, or checking the TMAH Compliance Option, is ® Pass ❑ Pass ❑ Pass ❑ Pass a pass. 13 Fail 13 Fail ❑ Fail 11Fail Enter Pass or Fail Reg: 214-A0038949A-M2500001A-0000 Registration Date/Time: 2014/05/30 09:58:24 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2013 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 6) Site Address: I Enforcement Agency: Permit Number: 54-163 Shoal Creek System 2, La Quinta CA 92253 City of La Quinta STMS - Sensor on the Evaporator Coil System Name or System i Identification/Tag - _, 3 The sensor is factory installed, or field installed according to manufacturer's specifications, or is installed by methods/specifications approved by the Executive Director. , , ❑ Yes ❑ No 1 ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No The sensor wire is terminated with a standard mini plug suitable for connection to a digital thermometer. 4 The sensor mini plug is accessible to the installing technician and the HERS rater without changing the airflow through the condenser coil ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No 5 iThe sensor measures the saturation temperature of the coil within 1.3 degrees F ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No Yes to 3, 4, and 5 is a pass. Enter N/A if STMS are not ® N/A ❑ N/A ❑ N/A ❑ N/A applicable. ❑ Pass ❑ Pass ❑ Pass ❑ Pass Otherwise enter Pass or ❑ Fail ❑ Fail ❑ Fail ❑ Fail Fail STMS - Sensor on the Condenser Coil System Name or System 1 Identification/Tag - _, 6 The sensor is factory installed, or field installed according to manufacturer's specifications, or is installed by methods/specifications approved by the Executive Director. ❑ Yes ❑ No 1 ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No The sensor wire is terminated with a standard mini plug suitable for connection to a digital thermometer. 7 The sensor mini plug is accessible to the installing technician and the HERS rater without changing the airflow through the condenser coil ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No 8 IThe sensor measures the saturation temperature of the coil within 1.3 degrees F ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No Yes to 6, 7, and 8isa pass. Enter N/A if STMS are not ❑ N/A ❑ N/A ❑ N/A ❑ N/A applicable. ❑ Pass ❑ Pass ❑ Pass ❑ Pass Otherwise enter Pass or ❑ Fail ❑ Fail ❑ Fail ❑ Fail Fail Reg: 214-A0038949A-M2500001A-0000 Registration Date/Time: 2014/05/30 09:58:24 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2013 INSTALLATION CERTIFICATE CF-6R-MECH,-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 6) Site Address: Enforcement Agency: Permit Number: 54-163 Shoal Creek System 2, La Quinta CA 92253 City of La Quinta Standard Charge Measurement Procedure (for use if outdoor air dry-bulb temperature is 55°F or above) 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 temperature is less than 55°F, the installer must use the RA3.2.3 Alternate Charge Measurement Procedure (Weigh -In Charging Method). If the Weigh -In Method is used, the dwelling cannot be included in a sample group for HERS verification compliance.) Space Conditionina Svstems System Name or Identification/Tag System 1 (must be re -calibrated System Location or Area Served Whole House 4/1/2014 (must be re -calibrated Outdoor Unit Serial # 1323363HSF Outdoor Unit Make AMERICAN STANDARD Outdoor Unit Model 4A7A6036H1000AA Nominal Cooling Capacity 3 Tons Date of Verification 4/30/2014 Calibration of Diagnostic Instruments Date of Refrigerant Gauge Calibration 4/1/2014- (must be re -calibrated monthly) Date of Thermocouple Calibration 4/1/2014 (must be re -calibrated temperature (Tsu I db) monthly) Measured Temperatures (°F) System Name or Identification/Tag System 1 Supply (evaporator leaving) air dry-bulb temperature (Tsu I db) 50 Return (evaporator entering) air dry-bulb temperature (Treturn db) 104 Return (evaporator entering) air wet -bulb temperature (Treturn wb) Evaporator saturation temperature 50 (Teva orator sat) Condensor saturation temperature 104 (Tcondensor, sat) Suction line temperature (Tsuction) 57 Liquid Line Temperature (Tliquid) 94 Condenser (entering) air dry-bulb 90 temperature (Tcondenser, db) Reg: 214-A0038949A-M2500001A-0000 Registration Date/Time: 2014/05/30 09:58:24 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2013 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 6) Site Address: I Enforcement Agency: Permit Number: 54-163 Shoal Creek System 2, La Quinta CA 92253 1 City of La Quinta Minimum Airflow RPnuirPment 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 i Calculate: Actual Temperature Split = Treturn db - Tsupply, db Target Temperature Split from Table RA3.2-3 using Treturn wb and Treturn db Calculate difference: Actual Temperature Split - Target Temperature Split = Passes if difference is between -3°F and +3°F or, upon remeasurement, if between -3°F and -100°F Enter Pass or Fail Note: Temperature Split Method:Calculation is not necessary if actual Cooling Coil Airflow is 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 or Identification/Tag. " System, i Calculated Minimum Airflow Requirement 900 (CFM) Measured Airflow using RA3.3 procedures 971 (CFM) Measurement Method Flow Hood Passes if measured airflow is greater than or equal to the calculated minimum airflow PASS requirement. Enter Pass or Fail Reg: 214-A0038949A-M2500001A-0000 Registration Date/Time: 2014/05/30 09:58:24 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2013 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS tefrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 6; Site Address: Enforcement Agency: Permit Number: 54-163 Shoal Creek System 2, La Quinta CA 92253 City of La Quinta Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for fixed orifice metering device systems System Name or Identification/Tag System 1 Calculate: Actual Superheat = 10.0 Tsuction - Teva orator sat Target Superheat from Table RA3.2-2 g using Treturn wb and Tcondenser, db 4-25 Calculate difference: 1 Actual Superheat - Target Superheat = System passes if difference is between -5°F and +5°F PASS' Enter Pass or Fail 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 = 10.0 Tcondenser, sat - Tli uid Target Subcooling specified by g manufacturer 4-25 Calculate difference: 1 Actual Subcooling - Target Subcooling = System. passes if difference is between ` -3°F and .+3°F PASS' Enter Pass or Fail Metering Device Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and. electronic expansion valve (EXV) systems. System.Name or Identification/Tag. System 1 Calculate: Actual Superheat = 7.0 Tsuction - Teva orator 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) System passes if actual superheat is within the allowable superheat range PASS Enter Pass or Fail Reg: 214-A0038949A-M2500001A-0000 Registration Date/Time: 2014/05/30 09:58:24 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2013 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 6 of 6) Site Address: Enforcement Agency: JPermit Number: 54-163 Shoal Creek System 2, La Quinta CA 92253 City of La Quinta 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: 374937 Date Signed: 14/30/2014 position With Company (Title): System meets all refrigerant charge and Name of TPQCP (if applicable): Control Program (TPQCP)? ❑ Yes ❑ No airflow requirements. PASS Enter Pass or Fail ® Residential Appendix RA3.2.2 requires that if the outdoor temperature is between 55°F and 65°F the return air dry bulb temperature shall be maintained above 70°F during the Standard Charge Measurement Procedure. The signature of the Responsible Person in the declaration statement below certifies this requirement has been met for all applicable system verifications reported on this certificate. DECLARATION STATEMENT . I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. . I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized representative of the person responsible for construction (responsible person). . I certify that the installed features, materials, components, or manufactured devices identified on this certificate (the installation) conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the enforcement agency. . I understand that a HERS rater will check the installation to verify compliance, and that that if such checking identifies defects, I am required to take corrective action at my expense. I understand that Energy Commission and HERS provider representatives will also perform quality assurance checking of installations, including those approved as part of a sample group but not checked by a HERS rater, and if those installations fail to'"meet the requirements of such quality assurance checking, the required corrective action and additional checking/testing of other installations in that HERS sample group will be performed at my expense. . I reviewed a copy of the Certificate of Compliance (CF -1R) form approved'by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on.the CF -1R that apply to the installation have been met. . I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all 1 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) Palm Desert Air Conditioning Co Responsible Person's Name: Responsible Person's Signature: Karl Brown Karl Brown CSLB License: 374937 Date Signed: 14/30/2014 position With Company (Title): Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? ❑ Yes ❑ No Reg: 214-A0038949A-M2500001A-0000 Registration Date/Time: 2014/05/30 09:58:24 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2013 INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS Duct Leakage Test — Existing Duct System (Page 1 of 2) Site Address: 54-163 Shoal Creek System 1, La Quinta CA 92253 Enforcement Agency: Permit Number: (System 1) City of La Quinta 7 Enter the Duct System Name or Identification/Tag: System i 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 Leakaqe Diaqnostic Test - existina 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 30% 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.) Determine nominal Fan Flow using one of the following three. calculation.methods. ✓ ® Cooling system method: Size of;condenser" in Tons 3 • x 400 = 1200 'CFM' ✓ ❑ Heating system method: 21.7'x: ' Output Capacity in Thousands of Btu/hr = _ CFM ✓ ❑ Measured system airflow using RA3.3 airflow, -test, procedures:.._ CFM Option 1 used then: 1 Allowed leakage = Fan Airflow 1200 x 0.15 _ ISO CFM Actual Leakage = 150 CFM Pass if Actual Leakage is less than Allowed leakage ® Pass ❑ Fail Option.2 used then: 2 Allowed leakage = Fan Airflow_ - x 0.10 = _ CFM Actual Leakage to outside = — CFM -Pass if Actual leakage to outside is less than Allowed leakage ❑ Pass ❑ Fail Option 3 used then: Initial leakage prior to start of work = CFM Final leakage after sealing all accessible leaks using smoke test = _ CFM 3' Initial leakage _ - Final leakage _ = Leakage reduction_CFM ((Leakage reduction _/ Initial leakage ) x 100% _ Reduction Pass if % Reduction >= 60% Pass Fail Option 4 used then: 4 All accessible leaks repaired using smoke test. HERS rater must verify (No Sampling). Pass if all accessible leaks have been repaired using smoke ❑ Pass ❑ Fail Reg: 214-A0038948A-M2100001A-0000 Registration Date/Time: 2014/05/30 09:48:56 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March -2010 INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS Duct Leakage Test - Existing Duct System (Page 2 of 2) Site Address: 54-163 Shoal Creek System 1, La Quinta CA 92253 Enforcement Agency: Permit Number: (System 1) City of La Quinta Date Signed: 4/30/2014 ® Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off during duct leakage testing. CFI OA ducts that utilize controlled motorized dampers, that open only when OA ventilation is required to meet ASHRAE Standard 62.2, and close when OA ventilation is not required, may be configured to the closed position during duct leakage testing. ® All supply and return register bi66ts,;must be sealed. to the drywall if.smoke test is utilized for compliance - applies to duct leakage compliance option 3 (leakage reduction by 60%) and option 4.(fix all accessible leaks) described above. ® New duct installations cannot utilize building. cavities as plenums or platform returns in' lieu of ducts. ® Mastic and draw bands must be used in combination with cloth backed rubber adhesive duct tape to seat ' leaks at all new duct connections DECLARATION. STATEMENT • I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. • I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized representative of the person responsible for construction (responsible person). • I certify that the installed features, materials, components, or manufactured devices identified on this certificate (the installation) conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the enforcement agency. • I understand that a HERS rater will check the installation to verify compliance, and that that if such checking identifies defects, I am required to take corrective action at my expense. I understand that Energy Commission and HERS provider representatives will also perform quality assurance checking of installations, including those approved as part of a sample group but not checked by a HERS rater, and if those installations fail to meet the requirements of such quality assurance checking, the required corrective action and additional checking/testing of other installations in that HERS sample group will be performed at my expense. • I reviewed a copy of the Certificate of Compliance (CF -IR) form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF -1R that apply to the installation have been met. • I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. I will ensure that all Installation Certificates will come from a HERS provider data registry for multiple orientation alternatives, and beginning October 1, 2010, for all low-rise residential buildings. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) Palm Desert Air Conditioning Co Responsible Person's Name: Responsible Person's Signature: Karl Brown Karl Brown CSLB License: 374937 Date Signed: 4/30/2014 Position With Company (Title): Is this, installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? Q Yes ❑ No Reg: 214-A0038948A-M2100001A-0000 Registration Date/Time: 2014/05/30 09:48:56 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms ' March 2010 INSTALLATION CERTIFICATE CF-6R-MECH-25-HER9 Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 6) Site Address: Enforcement Agency: Permit Number: 54-163 Shoal Creek System 1, La Quinta CA 92253 City of La Quinta 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, unless the TMAH Compliance Option is chosen. STMS are only required for completely new or replacement space -conditioning systems that utilize prescriptive compliance method. TMAH - Access Holes in Supplv and Return Plenums of Air Handler System Name or Identification/Tag System i System Location or Area Served Whole House 5/16 inch (8 mm) access hole 1 upstream of evaporative coil in the ® Yes ❑ Yes ❑ Yes ❑ Yes return plenum and labeled according ❑ No ❑ No ❑ No ❑ No to Figure.in Section RA3.2.2.2.2. Return side of the duct system>is la located entirely within. conditioned ❑ Yes ❑ Yes ❑ Yes ❑ Yes space and return airflow temperature ❑ No::, ❑ No 0 N ." . ❑ No to be measured at the return. grille. 5/16. inch (8 mm) access hole 2 downstream of evaporative coil in the ® Yes ❑.Yes ❑ Yes 13Yes ' supply plenum and labeled according ❑ No ❑ No ❑ No ❑ No to Figure in Section RA3.2.2.2.2. The TMAH Compliance Option should be checked only if it is physically impossible to drill the TMAH as required by Section RA3.2.2.2.2. Using this Compliance Option requires the HVAC installer to annotate on the HERS Provider's data registry an explanation as to why the TMAH cannot be installed on the system, and photographs of the equipment on which the TMAH cannot be installed. Use of this Compliance Option also requires minimum airflow verification through the direct measurement of airflow per RA3.3 For more information see httr)://www.enerciv.ca.gov/titie2412008standards/sr)ecial case aooliance/ TMAH Compliance Option ❑ ❑ ❑ ❑ Yes to 1 and 2, or Yes to la and 2, or checking the TMAH Compliance Option, is ® Pass ❑ Pass ❑ Pass ❑ Pass a pass. ❑ Fail ❑ Fail ❑ Fail ❑ Fail Enter Pass or Fail r Reg: 214-A0038948A-M2500001A-0000 Registration Date/Time: 2014/05/30 09:54:38 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2013 INSTALLATION CERTIFICATE CF-611-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 6) Site Address: Enforcement Agency: Permit Number: 54-163 Shoal Creek System 1, La Quinta CA 9 1 City of La Quinta STMS - Sensor on the Evaporator Coil System Name or System 1 Identification/Tag . - 3 The sensor is factory installed, or field installed according to manufacturer's specifications, or is installed by methods/specifications approved by the Executive Director. ❑ Yes ❑ No 1 ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No The sensor wire is terminated with a standard mini plug suitable for connection to a digital thermometer. 4 The sensor mini plug is accessible to the installing technician and the HERS rater without changing the airflow through the condenser coil ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No 5 IThe sensor measures the saturation temperature of the coil within 1.3 degrees F ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No Yes to 3, 4, and 5isa pass. ❑ N/A Enter N/A if STMS are not ❑ N/A pass. Enter N/A if STMS are not ® N/A ❑ N/A ❑ N/A ❑ N/A applicable. ❑ Pass ❑ Pass ❑ Pass ❑ Pass Otherwise enter Pass or ❑ Fail ❑ Fail ❑ Fail ❑ Fail Fail STMS - Sensor on the Condenser Coil System Name or System 1 . Identification/Tag . . - 6 The sensor is factory installed, or field installed according to manufacturer's specifications, -or is installed by methods/specifications approved by the Executive Director..:.'..':'.. " 13 Yes ❑ No ❑ Yes ❑ No ❑ Yes; ❑,No❑Yes 13No. The sensor wire is terminated with a standard; mini plug suitable.for`. connection to a -digital thermometer. 7 The sensor,mini plug is accessible to the installing technician and the HERS rater without changing the airflow through the condenser coil . ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No 8 IThe sensor measures the saturation temperature of the coil within 1.3 degrees F ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No Yes to 6, 7, and 8 is a pass. ❑ N/A Enter N/A if STMS are not ❑ N/A ❑ N/A ❑ N/A applicable. ❑ Pass ❑ Pass ❑ Pass ❑ Pass ❑ Fail Otherwise enter Pass or ❑ Fail ❑ Fail ❑ Fail Fail Reg: 214-A0038948A-M2500001A-0000 Registration Date/Time: 2014/05/30 09:54:38 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms ' March 2013 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 6) Site Address: I Enforcement Agency: Permit Number: 54-163 Shoal Creek System 1, La Quinta CA 92253 City of La Quinta Standard Charge Measurement Procedure (for use if outdoor air dry-bulb temperature is 55°F or above) 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 temperature is less than 55°F, the installer must use the RA3.2.3 Alternate Charge Measurement Procedure (Weigh -In Charging Method). If the Weigh -In Method is used, the dwelling cannot be included in a sample group for HERS verification compliance.) Space Conditionina Svstems System Name or Identification/Tag System i (must be re -calibrated System Location or Area Served Whole House 4/1/2014 (must be re -calibrated Outdoor Unit Serial # 14014UTXSF Outdoor Unit Make AMERICAN STANDARD Outdoor Unit Model 4A7A6036H1000AA Nominal Cooling Capacity 3 Tons Date of Verification 4/30/2014, Calibration of Diagnostic: Instruments Date of Refrigerant Gauge Calibration - 4/1/2014 (must be re -calibrated monthly) Date of Thermocouple Calibration 4/1/2014 (must be re -calibrated temperature (Tsu I db) monthly) Measured Temperatures (°F) System Name or Identification/Tag System 1 Supply (evaporator leaving) air dry-bulb temperature (Tsu I db) 49 Return (evaporator entering) air dry-bulb temperature (Tretum db) 105 Return (evaporator entering) air wet -bulb temperature (Treturn wb) Evaporator saturation temperature 49 (Teva orator sat) Condensor saturation temperature 105 (Tcondensor, sat) Suction line temperature (Tsuction) 55 Liquid Line Temperature (Tliquid) 93 Condenser (entering) air dry-bulb 90 temperature (Tcondenser, db) Reg: 214-A0038948A-M2500001A-0000 Registration Date/Time: 2014/05/30 09:54:38 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2013 INSTALLATION CERTIFICATE CF-6111-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 6)1 Site Address: I Enforcement Agency: Permit Number: 54-163 Shoal Creek System 1, La Quinta CA 92253 1 City of La Quinta 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 i Calculate: Actual Temperature Split = Treturn db - Tsupply,db Target Temperature Split from Table RA3.2-3 using Treturn wb and Treturn db Calculate difference: Actual Temperature Split - Target Temperature Split = Passes if difference is between -3°F and +3°F or, upon remeasurement, if between -3°F and -100°F Enter Pass or Fail Note: Temperature Split Method Calculation is not necessary if actual Cooling Coil Airflow is verified using one of the airflow measurementprocedures 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 Re (CFM) = Nominal Cooling Capacity (ton) X.300 (cfm/ton) System Name or`IdentificationHag System L Calculated Minimum Airflow Requirement g00 (CFM) Measured Airflow: using RA3.3'procedures 933 (CFM) Measurement Method Flow Hood Passes if measured airflow is greater than or equal to the calculated minimum airflow PASS requirement. Enter Pass or Fail Reg: 214-A0038948A-M2500001A-0000 Registration Date/Time: 2014/05/30 09:54:38 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2013 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 6; Site Address: Enforcement Agency: Permit Number: 54-163 Shoal Creek System 1, La Quinta CA 92253 City of La Quinta Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for fixed orifice metering device systems System Name or Identification/Tag System 1 Calculate: Actual Superheat = 12.0 Tsuction - Teva orator sat Target Superheat from Table RA3.2-2 9 using Treturn wb and Tcondenser, db 4-25 Calculate difference: 3 Actual Superheat - Target Superheat = System passes if difference is between -5°F and +5°F PASS' Enter Pass or Fail 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 =* 12.0 Tcondenser, sat - Tli uid Target Subcooling specified by 9 manufacturer 4-25 Calculate difference: 3 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 System 1 Calculate`. Actual Superheat = 6.0 Tsuction - Teva orator 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) System passes if actual superheat is within the allowable superheat range PASS Enter Pass or Fail Reg: 214-A0038948A-M2500001A-0000 Registration Date/Time: 2014/05/30 09:54:38 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2013 J INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS' Refrigerant Charge Verification - Standard Measurement Procedure (Page 6 of 6) Site Address: I Enforcement Agency: Permit Number: 54-163 Shoal Creek System 1, La Quinta CA 92253 1 City of La Quinta 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: 374937 Date Signed: 14/30/2014 position With Company (Title): System meets all refrigerant charge and Name of TPQCP (if applicable): Control Program (TPQCP)? 0 Yes ❑ No airflow requirements. , PASS Enter Pass or Fail ® Residential Appendix RA3.2.2 requires that if the outdoor temperature is between 55°F and 65°F the return air dry bulb temperature shall be maintained above 70°F during the Standard Charge Measurement Procedure. The signature of the Responsible Person in the declaration statement below certifies this requirement has been met for all applicable system verifications reported on this certificate. DECLARATION STATEMENT . I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. . I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized representative of the person responsible for construction (responsible person). . I certify that the installed features;. materials, components, or manufactured devices identified on this certificate (the installation) conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the enforcement agency. . I understand that a HERS rater will check the installation to verify compliance, and that that if such checking identifies defects, I am required to take corrective action at my expense. I understand that Energy Commission and HERS provider representatives will also perform quality assurance checking of installations, including those approved as part of a sample group but not checked by a HERS rater and if those installations fail to meet the requirements of such quality assurance checking, the required corrective action and additional checking%testing of other installations in that HERS sample group will be performed.at my expense. ` . I reviewed a co of the Certificate of Compliance CF -1R forma roved`b the enforcement agency that identifies the -. PY P ( ) PP Y 9 cY. specific requirements for the installation.j certify that the requirements detailed on•the CF -1R that apply to the . •:F installation have been'met. , ' 'p . I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available •t 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 beoinnino October 1. 2010. for all low-rise residential buildings. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) Palm Desert Air Conditioning Co Responsible Person's Name: Responsible Person's Signature_ : Karl Brown Karl Brown CSLB License: 374937 Date Signed: 14/30/2014 position With Company (Title): Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? 0 Yes ❑ No ti Reg: 214-A0038948A-M2500001A-0000 Registration Date/Time: 2014/05/30 09:54:38 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms , March 2013