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12-0100 (RER)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 2r,..000001T00 Property Address: a811 CALLEMSTNALOA APN:.. 7-73-183-001-24. -000000- Application description: REMODEL - RESIDENTIAL Property Zoning: COVE RESIDENTIAL Application valuation: .3800 Applicant: VW"*fA- Architect or Engineer: JL4 LICENSED CONTRACTOR'S DECLARATION 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. License Class: - License No.: Date: Contractor: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from 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 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:). (_ 1 1, 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 pursuantto the Contractors' State License Law.). (_ 1 I am exempt under Sec. , 8AF.C. for this reason ✓Date: _mss t ` Owner: '/CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: _ Lender's Address: LQPERMIT Owner: SIYOUNG SONG 77811 CALLE SINAL( LA QUINTA, CA 922° Contractor: Owner VOICE (760) 777-7012 FAX•(760) 777-7011 INSPECTIONS (760) 777-7153 Date: 2/07/12 ------------------ 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 Policy Number 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 ' 3700 of the Labor.CocA I shall forthwith comply with those provisions. ✓ate: �c 2pplicant: ,. WARNING: FAILURE TO SECURE WYLPENALTIES ' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMIAND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS 1$100,0001. 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. r . 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 buil g.consuction, and hereby authorize representatives of this county to enter upon the above-mentioned prope y for i tr spection purposes. /ate: /.- ;gnature (Applicant or Agent): Application Number 12-00000100 ------ Structure Information WINDOW/HVAC CHANGEOUT AND INT WALL DEMO' --=-- Other struct info,: CODE EDITION 2010 Permit BUILDING PERMIT Additional desc . Permit Fee . . 63.00 Plan Check Fee 40.95, Issue Date Valuation . . ". . 3800 Expiration Date 8/05/12 Qty Unit Charge Per Extension BASE FEE 45.00 .2.00 9,0000.THOU BLDG.2,001-25,000 18.00 Permit ELECT - ADD/ALT/REM Additional desc . Permit Fee" . . 26.00 Plan Check Fee 6.50 -Issue Date Valuation 0 Expiration Date 8/05/12 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 11.0000 EA ELEC MISC ------------------------------------------------=-------=------------------- 11.00 Permit . . . •MECHANICAL Additional desc . Permit .Fee 33.00 Plan Check Fee 8.25 Issue Date Valuation . . . . 0 Expiration Date .. •.8/05/12 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 .9.0000 EA MECH APPL REP/ALT/ADD 9.00 1.00 9.0000 EA MECH B/C <=3HP/100K BTU 9.00 - - - - - - - - - Special Notes and Comments - - - - - - - - - - - - - - - - (3) WINDOW CHANGE OUT, HVAC CHANGE OUT., -WITH.RELOCATION AND INTERIOR WALL DEMO (CONVENTIONAL] THIS • PERMIT DOES NOT INCLUDE ALTERATION.TO CONVENIENCE OUTLET LOCATIONS, LIGHTING.OR PLUMBING. SEE OWNER/BUILDER FORM FOR PERMIT #12-0070.: 2010 CALIFORNIA BUILDING CODES. February 7,.2012 1:11:39 PM AORTEGA Other Fees . . . . BLDG STDS ADMIN.(SB1473) • 1.00 LQPERMIT Application Number 12-00000100 --------------------------------------------------------- Other Fees ... . . . . . ENERGY REVIEW,FEE ------------------- 4.10 Fee summary. Charged Paid Credited Due Permit.Fee Total -------- 122.00 --------------------- .00 ---------- .00 122.00 Plan Check Total 55.70 .00 .00 .. 55.70 Other Fee Total.; 5.10 .00 .00 5.10 Grand Total 182.80 ..00 00 182.80 , LQPDMI IT 5 Prescriptive Certificate,of.Compliance: Residential CF -1R -ALT Residential Alterations . age 1 of 5 Project Name: Climate Zone # S• # of Stories General Information Site Address: s / S' Enforcement Agency: Date: ' Z— Building Type®'S�ngle Family ® Multi Family Circle the Front Orientation: N, E, S, W, or degrees Conditioned Floor Area (CFA): Project Type: Ll Alterations Envelope Fenestration Roof Ll HVAC Replacement or Chane Out Duct Re lacement ® Water Heater ' NOTE: This form is not to be used for Newly Constructed Buildings or Additions Insulation Values For Opaque Surfaces (for Furring use the Mass and Furring Strips Construction table below) . As mbly Alteration Iffopeniing of framed cavity' alone= Alterations that involve the opening of the framed cavity of a wall, ceiling, orJloor must install the nurldatgry minimum insulation value per. §150 for the altered assembly. Fill in Columns A -C and enter mandatory insulation value in Column N. IffReplacement of entire assembly -Replacement ofan entire wall, ceiling, orJloor assembly requires the installation of Component Package- D insulation values in Table 151-C. Fill in Columns A - J. Opaque Surface Details For the furred portioned of Mass Walls see Furring Strips Construction Table below. A B I C D E F G I H I J Proposed °te Standard Values From JA4 Table Framing Thickness, Framed Continuous JA4 Proposed Tag/ Assembly Name Material Spacing, U- JA4 Table Cavity Insulation Assembly Assembly fD' or Type2 and Size2 or Other factor° Numbers R -value' R -Value? Row/Cole U -facto? Note: For furred assemblies, accounting for Continuous Insulation R -value, see Page JA4-3 and Equation 4-1. For calculating furred walls use the Mass and Furring Construction table below. 1. For Tag/ID indicate the identification name that matches the building plans. 2. Indicate the Assembly Name or type: Roof/Ceiling, Walls, Floors, Slabs, Crawl Space, Doors and etc ... indicate in column G the Frame material and Size: For Wood, Metal, Metal Buildings, Mass, enter 2x4, 2x6, or etc... see JA4 for other possible frame type assemblies. 3. Enter the thickness for mass in inches or Spacing between framing members enter; 16 "or 24 "OC; or Other for all other assembly description such as Concrete Sandwich Panel, Spandrel Panel, Logs, Straw Bale Panel and etc.... 4. Based on the Climate Zone; enter the equivalent U factor found in JA4 Table based on the R -Value from Table 151-B, C, or D 5. Enter the Table number that closely resembles the proposed assembly. 6. Enter the R -value that is being installed in the wall cavity or between the framing; otherwise, enter "0 ". 7. Enter the Continuous Insulation R -value for the proposed assembly; otherwise, enter "0 ". 8. Enter the row and column of the U factor value based on Column F Table Number and enter the Assembly U factor in Column J 9. The Proposed Assembly U factor, Column J, must be equal to or less than the Standard U factor in Column E to comply. Furring Strips Construction Table for Mass Walls Onl A I B I C T—D-77 E F I G I H I__T__J7 K L M Proposed Properties of Masonry and Concrete Added Interior or Exterior Insulation Walls From Reference in Furring Space from Reference Joint Appendix Table 4.3.5 4.3.6 4.3.7 Joint Appendix Table 4.3.13 U U y A cd Assembly CL d ` o .= o N ,4. Final:) Mass Name orJA4 Table 2 'Thickness' Assemb V7 T Number 41' -factor Comment �1�, AY,�+.�i��e�ri � • C_t�F�'� r:.:::� .c. � �5:uk.d�A��,li ����.�t��! ' eE ..ulh: s�:"b�"�+•' .•'�`ia�s�a�•ur�� '.�-r�!:L�li-,�-t�FJ�r' ¢ as-. . .�. 2008 Residential Compliancei - %- 0y/ Prescrietive,Certificate of Compliance: Residential CF -I -R -ALT Residential Alterations a e 2 of 5 Project Name: Climate Zone # # of Slories Mass and Furring Strips Construction(footnotes) I, Indicate the type of assembly to include; Hollow Unit Masonry Walls, Solid Unit Masonry, Solid Concrete Walls, Etc. Additional assemblies can befound Reference Joint Appendix JA4. 2. This is the U -Factor based on the thickness of the assembly in inches. 3. The R -value of the insulation to be added on the interior or exterior of the assembly. 4. The Calculated R- Value is the R -value of the furred out section of the assembly. -6.The- Final Assembly is calculated using Equation 4-2 or Equation 4-4of the Reference Joint Appendix JA4. The equation is the inverse of Column added.to Column L Column K is the inverse from column J. 7. Insert the calculated U- actor value on to the O a ue Surface Details in Column J FEaSTRATION PROPOSED AREAS Replacing window alone — Replacement windows shall meet the U -Factor and SHGC Value requirements of Component Package D in Table 151-C. The Tota! Fenestration and West facing Area requirements are not applicable. Adding 50ft2 or less of window area —Newly installed windows shall meet the U -Factor and SHGC Value requirements of Component Package D in Table 151-C. ® Adding more than 50ft2 of window area — Newly installed windows shall meet the U -Factor and SHGC Value and the Fenestration Area requirements of Component Package D in Table 151-C. Complete the Altered Fenestration Allowed Area Table on Page 2 of the CF -1 R -ALT Orientation C. Fenestration Type and Frame (North, East, indow, Glass Door or Skylight) o , West) PropsedArear Maximum Maximum, NFRC or Default (ft U -facto?•' SHGC, 1.4 Values F G CFA of Allowed Existing Allowed 1. Fenestration area is the area of total glazed product (i.e. glass plus frame). Exception: When a door is less than 50% glass, the fenestration area may be the glass area plus a "2 inch frame " around the glass. 2. Enter value from Component Package D Requirements in- Table 151-C. 3. Actual fenestration products installed and as indicated in CF -6R -ENV Form shall be equivalent to or have a lower U factor and/or a lower SHGC value than that specified on the CF -IR ALT Form. 4. Submit a completed WS -31? Form if a reduced SHGC is calculated with exterior shading. 5. Ifapplicable at this stage enter "NFRC" or NFRC Certified windows or are CEC "Default " values found in Table 116-A or B. ALTERED FENESTRATION ALLOWED AREAS (Complete if more than 50ftz offenestration is added) A B C. D E F G CFA of Allowed Existing Allowed Entire %of Fenestration Area Fenestration Area Proposed Area' .4 Dwelling CFA',' Areal Removed Added A x B -D + C Total Fenestration —Area Area' ft West Fenestration Area . (Required In CZ's 2,4&7-15 1. The Proposed West Fenestration Area includes West -sloping skylight area and any other skylight area with a pitch less than 1:12. 2. Enter 20% when no West orientation restriction or 15% when West fenestration is being installed in Climate Zones 2, 4, & 7-15. Note that the maximum allowed fenestration can only be 5% of the CFA as indicated in Column F. Column G must be equal to or less than Column F. 3. In climate zones 2, 4, 7-15, no more than 5% of the CFA is allowed for west facing glazing. 4. Existing Fenestration area must be counted toward the maximum allowed 15% or 20% of the whole building and calculated in Column G. The Proposed Area must be less than or equal to Column F. 5. Enter the fenestration removed as part of the alteration if arty in column D. 6. Enter the Fenestration area that is being added as part of the alteration. i[el'1!,'l�riTlirJ%� ��i!Ctili}:I� �il<.Aylaiifii]!� ursi 2008 Residential Compliancei .2010 [Simplified Prescriptive Cer.tificate'of Compliance: 2008' LC.hmate Zones 10 to 15 Site Addre, s + " -7 'C'A.LLQ >%tilA ,,, EnJ u' "'unt up—e— List Minimum Efficienc •Z Du �O P ckaged Unit rnace // O A insulation requirement Over Indoor Coil F U E ❑ COP OS etback ondensing Unit VSEER O EER f7'HSPF �'C O Resistance replan O R sideiyialHVA CAlteraations CF-IR-ALT_HVAC cement 4gency.: 8 Date: Permit t1: Conditioned Floor A insulation requirement Area Thermostat t0 ft of ducts, added or OS etback ed' in unconditioned space Served by system W1101 already (CZ 10-13) (CZ l4-lsl l 3040 sf present. must be installed) , O Other ❑ R 1. Equipment T}pe.• Choose the equipment being installed, iif more than one system., use another CF -I R -ALT -HVAC for each system. 2. Minimum Equipment EJJicleneles: l3 SEER, 78%AFUE. 7.7HSPFfortypical residential jystems. 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. BeginningOctober 1, 2010 a r tered co of the CF -1R and CF -6R shall also be on site for final Inspection. 1. HVAC Changeout Required Forms: • All HVAC Equipment replaced CF -6R forms: MECH-04,-MECH-2I-HERS and (for split systems) MECH- 25 -HERS CF -4R forms: MECH- 21 and fors lit stems MECH-25 • Condenser Coil and/or • Indoor Coil and /or CF -6R forms: 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(Minimtun Air Flow Requirement), TMAH For Packaged Units: Duct leakage < 15 percent Exempted f�rnn duct leakage testing if ❑ 1 Duct system was documented to have been previously sealed and confirmed through -KERS verification, or O 2. Duct systems with less than 40 linear feet in unconditioned space, or O 3. Existingducts stems are constructed, insulated or sealed with asbestos ❑ 2. New HVAC S stem Required Forms: . Cut in or Changeout with new ducts: (all new ducting god all CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS new equipment) CF -4R forts: 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. I -or Packaged Units: Duct leak a <6 percent O 3. New Ducts with Re lacement Requtred�Formg:• • Includes replacing or installing all new ducting CF -6R fortes: MECH-04, MECH-20-HERS,and (for split systems) MECH-25-HERS and/or outdoor condensing unit and/or indoor CF -4R fonts: MECH-20 and (for split systems) MECH-25 coil and/or furnace. Not all equipment changed. For Split Systems: Duct leakage < 6 percent, RC, CCA > 300 CFMhon, TMAH For Packaged Units: Duct leakage < 6 percent O 4. New Ductingover 40 feet Required Forms: • Includes adding or replacing more than 40 linear feet of duct in unconditioned space. CF -6R forms: MECH-04, MECH-2I-HERS CF -4R fortes: MECH-21 For split system or packaged units: Duct leakage < 15 percent ❑ EXCEPTION: Existingducts stems constructed,insulated or sealed with asbestos Contractor (Documentation Author's /Responsible Designer's Declaration Statement) • 1 cenifj, that this Certificate of Compliance documentation is accurate and complete. • 1 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 I and 6 of the California Code of Regulations. • i he .legion features identified on this Certificate of -Compliance are consistent with the information documented on other applicable compliance fortes, worksheets. calculations, plans ands specifications submitted to the enforcement agency fora oval with the rmit application. Name: VLJ© C, D�AD,� Signatum: WA Company: Address: City/Statc/L ip: 2008 Residential Compliance Forms License: none(-7�.) 7,72_5721h I March 2010 Prescriptive Certificate of Compliance:. Residential CF=1.R=ALT,. Residential Alterations a' e 5 of Project Name: 777 ne # # of Stories 1 HERS VERIFICATION SUMMARY The enforcement agency should pay special attention to the HERS Measures specified in this' checklist below. A rompleted and signed CF -4R Form for all the measures specified shall be submitted to the building inspector before final inspection Duct Sealing & Testing HERS verification is required for this measure. OYES ® NO YES: In Climate Zones 2 and 9-16, if more than 40 linear feet of new or replacement ducts are installed in unconditioned space, the ducts are to be sealed per §152(b)1Dii andthe newly installed ducts are to be insulated per §151(010. ® EXCEPTION: Existing duct systems that are extended, which are constructed, insulated or sealed with asbestos. ®YES ®NO YES: In Climate Zones 2 and 9-16, if the existing space -conditioning system (HVAC equipment and ducting) is replaced, the ducts are to be sealed per §I52(b)IDi. ® YES ®NO YES: In Climate Zones 2 and 9-16, if the existing HVAC equipment is replaced (including the replacement of the air handler, outdoor condensing unit of a split system, cooling or heating coil, or the furnace heat exchanger) the ducts are to be sealed per §I52(b)IE. 13 EXCEPTION: Duct systems that are documented to have been previously sealed confirmed through HERS verification in accordance with procedures in the Reference Residential Appendix RA3. ® EXCEPTION: Duct systems with less than 40 linear feet in unconditioned space. EXCEPTION: Existing ducts stems constructed, insulated or sealed with asbestos. Refrigerant Charge -Split System HERS verification is required for this measure. ® YES ®NO YES: In Climate Zones 2 and 8-15, when the existing HVAC equipment is replaced (including the replacement of the air handler, outdoor condensing unit of a split system A/C or heat pump, cooling or heating coil, or the furnace heat exchanger) a refrigerant charge -measurement shall be verified per § 152(b)] F. Central Fan Integrated (CFn Ventilation System and Fan Watt Draw The ventilation requirements of § 150 o do not apply to existing residential homes. Ducted Split Systems - Air Conditioners and Heat Pumps: Airflow HERS verification is required for this measure. ® YES 0 NO YES: In Climate Zones 10 through 15, when the existing space -conditioning system (HVAC equipment and ducting) is replaced, the airflow and fan watt draw shall be verified per § 152 b 1 Ci to meet therequirements of §151(07B. Documentation Author's Declaration Statement • I certify that this Certificate of Compliance documentation is accurate anjftomplete. Name:. OGI-0 C' 1)64c'ArA Signa e: Company: Date: r Address: If Applicable CEA or CEPE (Certification #): City/State/Zip: Phone: Responsible Building Designer's Declaration Statement • I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the building design identified on this Certificate of Compliance. • I certify that the energy features and performance specifications for the building 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 building design features identified on this Certificate of Compliance are consistent with the information provided to document this building design on the other applicable compliance forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application. Name: Signature: Company: Date: Address: License: City/State/Zip: Phone: For assistance or questions regarding the Energy Standards, contact- the Energy Hotline at: 1-800-772-3300. 2008 Residential Compliance Forms March 2010 f tt IY , .f �. ..: lli' ' BIn. #City, of .La Qui tta Building 8r Safety Division P.O. Box 1504, •78-495 Calle Tampico La.Quinta, CA 92253 - (760) 777-7012 Building Permit Applicadon'and Tracking Sheet Perinit # Project Address: ". Owner's Name:.Q Gil• vol._�10PJ A. P. Number. Address: -77-61( Ca(..& .S (N,-JLoA Legal- Description: Contractor. City, ST, Zip: 22-5 73 Telephone: V.f Address: Project Description: City, ST, Zip: W I,�J]V�tif S Telephone: z I �(t J Oarj its --L State Lic. # : City Lie #; (I Arcfi. Engr., Designer. wu�`^(Z. �vJa • i J. 1 I+6 Ei ice -'– Address: City., ST, Zip: Telephone: State Lic. #: Construction Type:. Occupancy: Project type (circle one): New Add'n Alter Repair Demo Sq. Ft.: $Stories: #Units: Name of Contact Person L)W� O I ��7 Telephone # of Contact Person `.6 0 2 72 —SZ%% Q Estimated Value of Project: 3, Z,1 � 0 APPLICANT: DO NOT WRITE BELOW THIS UNE # Submittal Req'd 'Reed - TRACKING PERMPY FEES Plan Sets Plan Check submitted Item Amount Structural Cala. Reviewed, ready for corrections Plan Check Deposit. . Truss Calm Called Contact Person Plan Check Balance Tide 24 Calcs. Pians picked up Contraction Flood plain plan Plan resubmitted Mechanical Grading plan 2'a Review, ready for correctionstissue Electrical Subeontactor List Called Contact Person Plumbing Grant Deed ' Plans picked up &hLL ILOA. A Approval Plans resubmitted Grading ItV HOUSE:- ''" Review; ready for correctionslissac Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr - Date of permit'issue School Fees Total Permit Fees. UP F; MEE LU ISTALLATION CERTIFICATE CF-6111-MECH-1 )ace Conditioning Systems, Ducts and Fans - - APage 1 of,' ite Address: siiii.l c9tVAr-Enforcement Agency: Permit Number: 7811, La Quinta CA.92253 (System 1) City of La Quinta 12-0100 ' Space Conditioning Systems Heating Equipment Equip Type (package- heat pump) CEC Certified Mfr. Name and Model Number' a ARI Reference Number2 # of Identical Systems Efficiency (AFUE, etc.)1, 3 (>=CF -1R Jalue)4 Duct Location (attic, crawl- space, " etc.) r. Duct R -value Heating Load (kBtu/hr) Heating Capacity (kBtu/hr) Split GOODMAN 1 80 AFUE Attic R-4.2' , " Type y and EER) (attic, " (package ARI # of 1, 3 crawl= Cooling 'Cooling heat CEC Certified Mfr. Name Reference Identical (>=CF -1R 'space, Duct ;Load Capacity pump) and Model Number Number2 Systems value)4 etc.) R -value (kBtu/hr) , (kBtu/hr) Split GOODMAN 13 SEER Cooling Equipment , I 1. If project is new construction, see Footnotes to Standards Table 151-8 and Table 151-C for duct ceiling alternative compliance: 2. ARI Reference Number can be found by entering the equipment model number at http://www.aridirectory.orglarilac.php# 3. Listed efficiency on this page must be greater than or equal ( ? ) to the value shown on the CF -ZR form. 4. When CF -1R is reference it is also applicable to the CF -1R, CF -1R -AA or CF -1R -ALT, •, >_ , ALL BOXES MUST BE CHECKED TO BE A VALID FORM © §110-§113: HVAC equipment is certified by the California Energy Commission.: , 0 §150(h): Heating and/or cooling loads calculated in accordancewith ASHRAE,•SMACNA; or ACCA. • . 0 §150(i): Setback Thermostat on all applicable heating and/or cooling systems meet the requirements of . §112(c). 4.§150(j)2: Pipe insulation for cooling system refrigerant suction; chilled water and brine lines meets minimum requirements of Table 150-B and includes a vapor retardant or is enclosed'entirely in conditioned space. - Reg: 212-A0014972A-M0400001A-0000 Registration Date/Time: 2012/03/26 22:05:48 HERS Provider:,Ca10ERTS, Inc. 2008 Residential Compliance Forms + �� '' August 2009 -Efficiency Duct Equip (SEER Location , Type y and EER) (attic, " (package ARI # of 1, 3 crawl= Cooling 'Cooling heat CEC Certified Mfr. Name Reference Identical (>=CF -1R 'space, Duct ;Load Capacity pump) and Model Number Number2 Systems value)4 etc.) R -value (kBtu/hr) , (kBtu/hr) Split GOODMAN 13 SEER ,A/Cgpa(' " rP' ' `'r l' •!' ., 11,EygygEttR -%Attic 5R_q72 � �II 'fix `S % 5`l � �.'-°JAS, • rX°/ ]y�$ rw...' F � dnA��, .X � � F� •�{�iS.. �f: + n - , ",oft,"f • :.._ .,.tri 'fig.. 1. If project is new construction, see Footnotes to Standards Table 151-8 and Table 151-C for duct ceiling alternative compliance: 2. ARI Reference Number can be found by entering the equipment model number at http://www.aridirectory.orglarilac.php# 3. Listed efficiency on this page must be greater than or equal ( ? ) to the value shown on the CF -ZR form. 4. When CF -1R is reference it is also applicable to the CF -1R, CF -1R -AA or CF -1R -ALT, •, >_ , ALL BOXES MUST BE CHECKED TO BE A VALID FORM © §110-§113: HVAC equipment is certified by the California Energy Commission.: , 0 §150(h): Heating and/or cooling loads calculated in accordancewith ASHRAE,•SMACNA; or ACCA. • . 0 §150(i): Setback Thermostat on all applicable heating and/or cooling systems meet the requirements of . §112(c). 4.§150(j)2: Pipe insulation for cooling system refrigerant suction; chilled water and brine lines meets minimum requirements of Table 150-B and includes a vapor retardant or is enclosed'entirely in conditioned space. - Reg: 212-A0014972A-M0400001A-0000 Registration Date/Time: 2012/03/26 22:05:48 HERS Provider:,Ca10ERTS, Inc. 2008 Residential Compliance Forms + �� '' August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-04 Space Conditioning Systems, Ducts and Fans (Page 2 of 2) Site Address: Enforcement Agency: Permit,Numbem 77811, La Quinta CA 92253 (System 1) City of La Quinta 11-0100`'"` Ducts and Fans §150(m): Duct and Fans 0 1. All air -distribution system ducts and plenums installed, sealed and insulated to meet the requirements of CMC Sections 601, 602, 603, 604, 605 and Standard 6-5; supply -air and return -air ducts and plenums are insulated to a minimum installed level of R-4.2 or enclosed entirely in conditioned space. Openings shall be sealed with mastic, tape or other duct -closure system that meets the applicable requirements of UL 181, UL 181A, or UL 1818 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 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. 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. 0 8. Gravity ventilating systems serving conditioned space have either automatic or readily accessible, manually operated dampers. 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. DECLARATION STATEMENT • I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. • I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized representative of the person responsible for construction (responsible person). • I certify that the installed features, materials, components, or manufactured devices identified on this certificate (the installation) conforms to all applicable codes and regulations, and the Installation is consistent with the plans and specifications approved by the enforcement agency. • I reviewed a copy of the Certificate of Compliance (CF -1R) form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF -1R that apply to the installation have been met. • I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) ZEPEDA AIR CONDITIONING Responsible Person's Name: Responsible Person's Signature: JOSE HERNANDEZ JOSE HERNANDEZ CSLB License: Date Signed: 13/28/2012 Position With Company (Title): 814359 Reg: 212-A0014972A-M0400001A-0000 Registration Date/Time: 2012/03/26 22:05:48 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 I INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS Duct Leakage Test = Existing Duct System ,. (Page 1 of 2) Site Address: A , s a; I Enforcement Agency: Permit Number: 77811, La Quinta CA 92253 (System 1) City of La Quinta 12-0100 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. I . ' 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 ,� t ❑ 2: -Measured leakage to outside less than 10% of Fan Flow 0 3. Reduce leakage by 60% and conduct smoke and fix all leaks + ` • r ❑ 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 nominaLFa,n Flow using one of the -following three calculation,methods. f ` ,„ems .. , �i fir''" ; ✓ 0 cool ing+system h6thod: Size of condenser.in Tons x 400 1600N CFM ✓ ❑ Heating system method:21 7 x Output Capacity in Th"'ousands ofBtu/hr = CFM I ❑ Measred system airflowlus1 RA3 3,airflow test ✓ _ CFM .,procedures y Optionused then Airflow`f 1 Allowed leakage —`Fan 0>15 X240 Actual Leakage = 127 CFM r 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: - • , t 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 k - - '. • ! ` + •ter ` .. Reg: 212-A0014972A-M2100001A-0000 Registration Date/Time: 2012/03/26 22:07:26 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 20101 - - '. • ! ` + •ter ` .. Reg: 212-A0014972A-M2100001A-0000 Registration Date/Time: 2012/03/26 22:07:26 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 20101 INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS Duct Leakage Test — Existing Duct System (Page 2 of 2) Site Address: Enforcement Agency: Permit Number: 77811, La Quinta CA 92253 (System 1) City of La QL 1 12-0100 0 Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off during duct leakage testing. CFI OA ducts that utilize controlled motorized dampers, that open only when OA ventilation is required to meet ASHRAE Standard 62.2, and close when OA ventilation is not required, may be configured to the closed position during duct leakage testing. 0 All supply and return register boots must# be, sealedAoahe drywall;if.smoke,test.is:,utilized,for compliance — applies to'duct leakage compliance option 3'(leakage reduction by 60%),and/optionj4 (fix all accessible leaks) described above. % r 0 New duct installations cannot -utilize building d1ities as plenums or platform returngsr in lieu of ducts. 13 Mastic and.draw b 'nd must beused ain co bination_with cloth backed.rubber;adhesive. ductape;to seal L -*0 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 -111) form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF -111 that apply to the installation have been met. • I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. I will ensure that all Installation Certificates will come from a HERS provider data registry for multiple orientation alternatives, and beginning October 1, 2010, for all low-rise residential buildings. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) ZEPEDA AIR CONDITIONING Responsible Person's Name: Responsible Person's Signature: JOSE HERNANDEZ JOSE HERNANDEZ CSLB License: Date Signed: Position With Company (Title): 814359 3/28/2012 Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? ❑ Yes ❑ No Reg: 212-A0014972A-M2100001A-0000 Registration Date/Time: 2012/03/26 22:07:26 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 t , System Location or Area Served Whole House 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 (SIMS) 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 a System Name or Identification/Tag System i System Location or Area Served Whole House 1 p Yes ❑ No - 5/16 inch (8 mm) access hole upstream of evaporative coil in the return plenum and labeled according to Figure in Section RA3.2.2.2.2. 2 p Yes ❑ No 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 ✓ 2 Pass ✓, ❑ Fail r1 4. . STMS'- Sensor on the Evaporator -Coil" System Name£dr Identification/Tag'"' , • � System;l IF 3 f ; '• - ❑Yes ®Nod The sensor is factory` installed, or fieldmstalled according to manufacturer's specifications, or ismstalled by methods/specifications approved b%he Executive .' No specifications, or is installed by methods/specifications approved by the Executive Director. r . ffr The sensor wiee is terminated withia•.standard mini�pfug suitable for connection hto ometer°�The.se sor hF 4 ❑,Yes No digital`ther mirn plug is.accessible toy mstalhng technician ' ❑ Yes ❑ No' ' " and the�HERSxrater-withoutchanging'the airflow through the condenser coil` 5 ❑ Yes ❑ No The sensor measures the saturation temperature of the coil within 1.3 degrees F Yes to 3, 4,. and 5 is a pass. Enter N/A if STMS are not p N/A - ✓ ❑ Passr� ✓ [3Fail applicable. Otherwise enter Pass or Fail- - ✓' ❑ Pass ✓ ❑ Fail applicable. Otherwise enter Pass or Fail •1. STMS - Sensor on the Condenser Coil System Name or Identification/Tag System i ' ' i _ The sensor is factory installed, or field installed according to manufacturer's, 6 � ❑Yes ' 10 Reg: 212-A0014972A-M2500001A-0000 Registration Date/Time: 2012'/03/26 22:15:17 HERS Provider: CalCERTS, Inc. �, 2008 Residential Compliance Forms August 2009 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 • 1 ❑ No IThe 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 •1. - Reg: 212-A0014972A-M2500001A-0000 Registration Date/Time: 2012'/03/26 22:15:17 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: 77811, La Quinta CA 92253 City of La Quinta 12-0100 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. Snaep Cnnditinnina Svstems System Name or Identification/Tag System 1 4 y N F Date of Th rmocoupie;,Calibration I �_ , 3/15/201 - .tl System Location or Area Served Whole House I l Outdoor Unit Serial # 1202025460 Outdoor Unit Make GOODMAN Outdoor Unit Model GSX1304SIBB Nominal Cooling Capacity Btu/hr 48000 Date of Verification 3/28/2012 caunranon of tmannostic instruments Date of Refrigerant Gauge Calibration 3/15/2012 (must be re -calibrated monthly) y N F Date of Th rmocoupie;,Calibration I �_ , 3/15/201 - .tl i' 41 r/. i t (must be re -calibrated monthly) f ! % I l Maaamirarl Tamnaraturaa'E�FI ! t 3 7 - j 7 . 7 1 ... t? System Name or Identif catfon/Tagl System 1 i ll / 4 1.2'/ 10 r '4 t f ! % Supply (evaporator leaving) air dry-bulb` -• --56- temperature (Tsupply, db) Return (evaporator entering) air dry-bulb 75 temperature (Treturn, db) Return (evaporator entering) air wet -bulb 58 temperature (Treturn, wb) Evaporator saturation temperature 38.5 (Tevaporator, sat) Condensor saturation temperature 92.5 (Tcondensor, sat) Suction line temperature (Tsuction) 51.2 Liquid Line Temperature (Tliquid) 82.7 Condenser (entering) air dry-bulb 80 temperature (Tcondenser, db) j Reg: 212-A0014972A-M2500001A-0000 Registration Date/Time: 2012/03/26 22:15:17 HERS Provider: CalCERTS, Inc.- 200B nca2008 Residential Compliance Forms August 2009 ..i, . ... •..�F Y3;;�• _ INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page.3 of 5) Site Address: Enforcement Agency: Permit Number: 77811, La Quinta CA 92253 City of i_Quinta 12-0100 j 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. _ • - - . _ r r System Name or Identification/Tag -System 1 - t Calculate: Actual Superheat = Calculate: Actual Temperature Split = Treturn, 19.00 i Tsuction - Tevaporator, sat db - Tsupply, db _ ' Target Temperature Split from Table RA3.2-3 21.4' Treturn,.wb and Tcondenser, db _ using Treturn, wb and Treturn, db ` Calculate difference: Calculate difference:`Actual Temperature Split - --2.4 - Actual Superheat - Target Superheat = Target Temperature Split = , System "passes if difference is between -50F and Passes if difference is between -3°F and +3°F or, +5°F upon remeasurement, if between -3°F and r - 4 PASS?r •.' , -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 Namexor Identification/Tag ; System 1`i E Calculated Minimum AirfloWRequirement (CFM) " N,�.. Measured�Airflow.using RA3 3 procedures (.CFM) _ . Passes if measured airflow is greater than or equal to the calculated minimum airflow requirement. ` Enter Pass or Fail Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for fixed orifice metering device systems System Name or Identification/Tag System 1 t Calculate: Actual Superheat = Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for fixed orifice metering device systems System Name or Identification/Tag System 1 Calculate: Actual Superheat = Tsuction - Tevaporator, sat Target Superheat from Table RA3.2-2 using Treturn,.wb and Tcondenser, db ' Calculate difference: - Actual Superheat - Target Superheat = System "passes if difference is between -50F and +5°F Enter Pass or Fail r Reg: 212-A0014972A-M2500001A-0000 Registration Date/Tine: 2012/03/26 22:15:17 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5) Site Address: Enforcement Agency: Permit Number: 77811, La Quinta CA 92253 1 City of La Quinta 12-0100 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 = 9.8 Tcondenser, sat - Tliquid Target Subcooling specified by manufacturer 10 Calculate difference: -0.2 Actual Subcooling - Target Subcooling = passes if difference is between d +3°F E PASS rte, r� U ; ---,1� i Enter Pass or Fail 1� PASS r 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 = 12.7 Tsuction - Tevaporator, sat Enter allowable superheat range from manufacturer's specifications (or use range 4-25 between 4°F and 25°F if manufacturer's specification is not available) System passes,if actual superheat is'within•the f ; rte, r� U ; ---,1� i allowable superheat range,` r 1� PASS r ,—_Enter Pass or Fail j Reg: 212-A0014972A-M2500001A-0000 Registration Date/Time: 2012/03/26 22:15:17 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5) Site Address:Enforcement Agency: Permit Number: 77811, La Quinta CA 92253 City of La Quinta 12-0100,i• Standard Charge Measurement Summary: I T - 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: Date Signed: 13/28/2012 Position With Company (Title): I "• 814359 Is this installation monitored by.a Third,Party Quality Name of TPQCP (if applicable): System meets all refrigerant charge and airflow requirements. PASS _ Enter Pass or Fail TT• I .i} ^'! < k fN ag + t DECLARATION STATEMENT • I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. • I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized representative of the person responsible for construction (responsible person). • I certify that the installed features, materials, components, or manufactured devices identified on this certificate (the installation) conforms to.all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the enforcement agency. ' . I 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 apprcved as part of a sample group but not checked by a HERS rater, and if those installations fail to meet the requirements of such quality assurance checking, the required corrective action and additional checking/testing,of other installations in that HERS sample group will be performed at my expense. • I reviewed a copy of the Certificate of Compliance (CF -111) form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF -111 that apply to the installation have been met. . I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. I will ensure that all Installation Certificates will come from a HERS provider data registry for multiple orientation alternatives, and beginning October 1, 2010, for all low-rise residential buildings. ti Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) ZEPEDA AIR CONDITIONING _ Responsible Person's Name: Responsible Person's Signature: JOSE HERNANDEZ JOSE HERNANDEZ - CSLB License: Date Signed: 13/28/2012 Position With Company (Title): I "• 814359 Is this installation monitored by.a Third,Party Quality Name of TPQCP (if applicable): } e3 . TT• I .i} ^'! < k fN ag + t DECLARATION STATEMENT • I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. • I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized representative of the person responsible for construction (responsible person). • I certify that the installed features, materials, components, or manufactured devices identified on this certificate (the installation) conforms to.all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the enforcement agency. ' . I 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 apprcved as part of a sample group but not checked by a HERS rater, and if those installations fail to meet the requirements of such quality assurance checking, the required corrective action and additional checking/testing,of other installations in that HERS sample group will be performed at my expense. • I reviewed a copy of the Certificate of Compliance (CF -111) form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF -111 that apply to the installation have been met. . I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. I will ensure that all Installation Certificates will come from a HERS provider data registry for multiple orientation alternatives, and beginning October 1, 2010, for all low-rise residential buildings. ti Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) Reg: 212,A0014972A-M2500001A-0000 Registration Date/Time: 2012/03/26 22:15:17 HERS Provider: CalCERTS, Inc.' 2008 Residential Compliance, IForms August 2009 ZEPEDA AIR CONDITIONING _ Responsible Person's Name: Responsible Person's Signature: JOSE HERNANDEZ JOSE HERNANDEZ - CSLB License: Date Signed: 13/28/2012 Position With Company (Title): I "• 814359 Is this installation monitored by.a Third,Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? ❑ Yes ❑ No Reg: 212,A0014972A-M2500001A-0000 Registration Date/Time: 2012/03/26 22:15:17 HERS Provider: CalCERTS, Inc.' 2008 Residential Compliance, IForms August 2009 INSTALLATION CERTIFICATE , :. ;_ CF-6R-MECH-21-HERS Duct Leakage Test — Existing Duct System "' (Page 1 of 2) _Site Address: 4 Enforcement Agency: Permit Number: 77811, La Quinta CA 92253 (System 1) City of La Quinta 12-0100-" Enter the Duct System Name or Identification/Tag: System 1 Enter the Duct System Location or Area Served: Whole House Note: Submit one Installation Certificate for each duct system that.must demonstrate compliance in the dwelling. This installation certificate is required for compliance for alterations and additions in existing dwellings to space conditioning systems and duct systems. Note: For existing dwellings, a completely new or replacement duct system can also include existing parts of the original duct system (e.g., register boots, air handler, coil, plenums, etc.) if those parts are accessible and they can be sealed. For a completely new. or replacement duct system installed in an existing dwelling, use the Installation Certificate titled "Duct Leakage Test - Completely New, or Replacement Duct System. " Duct Leakage Diagnostic Test - existing duct system r 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 16% 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 nominakFan Flow using one of the,following,three caiculation methods. ✓ 0 Cool ing*system method: Size of -condenser, in Tons4 x 400 1600CFM r , 5 f t , ✓ ❑ Heating system method:;21 7x Output Capacity m Thousands of.Btu/hr = CFM ✓❑Measured systems irflow usmgrRA3 Aj n_. 3:airflow_testrprocedures: CFM ' rI JV ?" , Option*bused then .f f 17 45V' 1 Allowed'ieakage—'Fan'Airflow' '"1600 x 0:1°5 —» 240 CFM � Actual Leakage = 127 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'n 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 ' 1 Pass if % Reduction•> 60% • 0 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 r • r t • i • r . Reg: 212-A0014972A-M2100001A-0000 Registration Date/Time: 2012/03/26 r 22:07:26 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS Duct Leakage Test - Existing Duct System (Page 2 of 2) Site Address: Enforcement Agency: Permit Number: 77811, La Quinta CA 92253 (System 1) City of La Quinta 12-0100 0 Outside air (OA) ducts for.Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off during duct leakage testing. CFI OA ducts that utilize controlled motorized dampers, that open only when OA ventilation is required to meet ASHRAE Standard 62.2, and close when OA ventilation is not required, may be configured to the closed position during duct leakage testing. 0 All supply andtreturn register boots must<be,sealed -to -the drywall,if.smoke.test.is•utilized-for compliance - applies to,duct leakage compliance,option 3`(leakage reduction by,"60%) a-ndloption 4i(fix all accessible leaks) de scribed above b° 0 New duct installations cannottutilize building cavltles as plenums or platform returns in lieu of ducts. j 0 Mastic and.draw bands must be used in,combination4ith:cloth backed.rubber,adhesive.duct tape;to seal 'Q 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 -111) form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF -111 that apply to the installation have been met. • I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. I will ensure that all Installation Certificates will come from a HERS provider data registry for multiple orientation alternatives, and beginning October 1, 2010, for all low-rise residential buildings. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) ZEPEDA AIR CONDITIONING Responsible Person's Name: Responsible Person's Signature: JOSE HERNANDEZ JOSE HERNANDEZ CSLB License: Date Signed: 13/28/2012 Position With Company (Title): 814359 Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? ❑ Yes ❑ No Reg: 212-A0014972A-M2100001A-0000 Registration Date/Time: 2012/03/26 22:07:26 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE* 2 •', CF-611-MECH-25-HERS _4 + Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 5) `s Site Address: Enforcement Agency: Permit Number: 77811, La Quinta CA 92253 .City of,La Quinta ,12-0100 - 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. r =: Temperature Measurement Access Holes (TMAH) and Saturation Temperature Measurement — •• -� Sensors (STMS) r; 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 - , _ 1y- ' System Location or Area Served Whole House I- -- - - 1 p Yes ` ❑ No 5/16 inch (8 mm) access hole upstream of evaporative coil in the return plenum and labeled according to Figure in Section RA3.2.2:2.2. 2 p Yes ❑ No 5/16 inch (8 mm) access hole downstream -of evaporative coil in the supply plenum and labeled according to Figure in Section RA3.2:2.2.2. . • Yes to 1 and.2 is a.pass. I Enter Pass or Fail - ✓ 2 Pass V. 0. Fail - STMS - Sensor on the Evaporator Coil System Namee6r-Identification/Tag'11£Y T, ,_ i l- ' r 3 ❑ Yes ®,No The sensor is factory instated; orfield`sinstalled according to manufacturer's specifications, or isiinstalled by methods%specifications approved by. the Executive ❑ Yes .❑_ No .�. Director. 1�y k 'y lThe sensor wire is terminated with a,standard mini plug suitable for connection to' a . .. .T' =y- { ,} A .t ar ft.a li d 4 ❑,Yes _. ®No digitalrthermometer. ;The sen or mmi plug is,accessible to3the mstalling,teehniaan the'HERS%rater:without changing the airflow Wrough the condenser coilX 5 ❑ Yes ❑ No ^ The sensor measures the saturation temperature of the coil within 1.3 degrees,F . Yes to 3, 4, and 5 is a pass. Enter N/A if STMS are not p N/A ✓ ❑Pass ✓ [I Fail , applicable. Otherwise enter Pass or Fail - ❑ 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 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 r. 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-AO014972A-M2500001A-0000 Registration Date/Time: 2012/03/26 22:15:17 HERS Provider: CalCERTS, Inc. 2.008 Residential Compliance Forms August 2009-- i Reg: 212-AO014972A-M2500001A-0000 Registration Date/Time: 2012/03/26 22:15:17 HERS Provider: CalCERTS, Inc. 2.008 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: 77811, La Quinta CA 92253 1 City of La QL 1 12-0100 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 Conditionina Svstems System Name or Identification/Tag System 1 (must be re -calibrated monthly) Date of Thermocouple'Calibration ' ,/'�f 3/15/201 j l System Location or Area Served * Whole House Outdoor Unit Serial # 1202025460 -._ ,a __• t,f �_, Outdoor Unit Make GOODMAN Outdoor Unit Model GSX130481BB Nominal Cooling Capacity Btu/hr 48000 Date of Verification 3/28/2012 calibration Or macinostic instruments Date of Refrigerant Gauge Calibration 3/15/2012 (must be re -calibrated monthly) Date of Thermocouple'Calibration ' ,/'�f 3/15/201 j l (must be re -calibrated monthly) r Measured Temberatures:(?F) 11 4r I -_-7 I ter' I L"1 6 System Name or Identification/Tagl System i Supply (evaporator leaving) air dry-bulb,' _l --.. 56 -._ ,a __• t,f �_, temperature (Tsupply, db) Return (evaporator entering) air dry-bulb 75 temperature (Treturn, db) Return (evaporator entering) air wet -bulb 58 temperature (Treturn, wb) Evaporator saturation temperature 38.5 (Tevaporator, sat) Condensor saturation temperature 92.5 (Tcondensor, sat) Suction line temperature (Tsuction) 51.2 Liquid Line Temperature (Tliquid) 82.7 Condenser (entering) air dry-bulb 80 temperature (Tcondenser, db) Reg: 212-A0014972A-M2500001A-0000 Registration Date/Time: 2012/03/26 22:15:17 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms 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: 77811, La Quinta CA 92253 ` -� City of La Quinta 12-0100 . Minimum Airflow RequirementY " 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, 19.00 ,, db - Tsupply, db _ •i Target Temperature Split from Table RA3.2-3 ; using T and T return, wb return, db r, Calculate difference: Actual Temperature Split -. -2.4 r Target Temperature Split = . ' •P Passes if difference is between -3°F and +3°F or, upon remeasurement; if between -3°F and ; -100°F PASS s , 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 o Identification/Tag' a) System i ; i r ai Calculated Minimum Airflow Requirement(CFM) Measured,Airflwhusing RA3.3procetlures (CFM) , J Passes if measured airflow is greater than or"' equal to the calculated minimum airflow requirement.- - ` ' 'Enter Pass or Fail > ' Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for fixed orifice metering device systems System Name or Identification/Tag System 1 , Calculate: Actual Superheat = ,, Tsuction - Tevaporator, sat 1 •i Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for fixed orifice metering device systems System Name or Identification/Tag System 1 , Calculate: Actual Superheat = ,, Tsuction - Tevaporator, sat 1 Target Superheat from Table RA3.2-2 using Treturn, wb and Tcondenser, db r, Calculatedifference: r Actual Superheat - Target Superheat = ' System passes if difference is between -5°F and +5°F Enter Pass or Fail t . • i .Reg: 212-A0014972A-M2500001A-0000 Registration Date/Time: 2012/03/26'22:15:17 HERS Provider: CalCERTS,'Inc. 2008 Residential CompliancelForms August 2009• INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5) Site Address: Enforcement Agency: Permit Number: 77811, La Quinta CA 92253 City of La QL 1 12-0100 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 = 9.8 Tcondenser, sat - Tliquid Target Subcooling specified by manufacturer 10 Calculate difference: • -0.2 Actual Subcooling - Target Subcooling = System passes if difference is between -3°F and +3°F PASS "� " ➢ J 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 = 12.7 Tsuction - Tevaporator, sat Enter allowable superheat range from manufacturer's specifications (or use range 4-25 between 4°F and 25°F if manufacturer's specification is not available) System passes if actual superheat is within>the I "� " ➢ J allowable superheat range / , /r f .-,Enter Pass or Fail f 1 NL 2 Reg: 212-A0014972A-M2500001A-0000 Registration Date/Time: 2012/03/26 22:15:17 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5) Site Address: Enforcement Agency: Permit Number: 77811, La Quinta CA 92253 City of La Quinta 12-0100 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 i CSLB License: Date Signed: Position With Company (Title): System meets all refrigerant charge and airflow 3/28/2012 Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): requirements. PASS " Enter Pass or Fail DECLARATION Sl • 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 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. r Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) ZEPEDA AIR CONDITIONING Responsible Person's Name:. Responsible Person's Signature: JOSE HERNANDEZ JOSE HERNANDEZ CSLB License: Date Signed: Position With Company (Title): 814359 3/28/2012 Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? ❑Yes ❑ No •: t - Reg: 212-A0014972A-M2500001A-0000 Registration Date_/Time: 2012/03/26 22:15:17 HERS Provider: Ca10ERTS, Inc. 2008 Residential ComplianceiForms August 2009