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12-1147 (MECH)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 12-00001147 Property Address: 79311 TOM FAZIO LN S APN: 766-041-012- - Application description: MECHANICAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 11500 Tit!t " BUILDING & SAFETY DEPARTMENT , BUILDING PERMIT Owner: PLY 79311 TOM FAZIO LANE SOUTH LA QUINTA, CA 92253 Contractor: Applicant: Architect or Engineer: AIR EXPERTS AIR PO BOX 94 LA QUINTA, CA 92 (760)777-1724 LiC. No.: 725283 ti VOICE (760) 777- 12 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 9/28/12 & CO rIITIONG-HTG 211 SE`P 23 0 2012 CITY OF LA QUINTA FINANCE DEPT. ------------------------------------------------------------------------------—------------------ UC. CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury th t I am Ii nsed under provisions of Chapter 9 (commencing with Section 70 01 of ivision 3 of the Busin ss and ofessionals Code, and my License '6 in 1W force and effect. License Cl ss: 20 /ate:�tt_ontractor: 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 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.). 1 _ 1 I am exempt under Sec. , B.&P.C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: Lender's Address: LQPERMIT 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 NORGUARD INS Policy Number PAWC334856 I certify that, in the performance of ork for which this permit is issued, I shall not employ any person in any manner so as eco subject to the workers' compensation_ laws of California, a d agree that, if I should 'come bject to the worker ' ns of Section 00 of the Labor Code, sh with those provisions. _ ate: plicant: WARN G: AIL R�CURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. 1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application, the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La 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 certifA P(iunature s application and statethat t � information is correct. I agree to comply with all city aand state laws relatingto b ildi construction, and hereb authorize representatives oft the above-mentioned property for i rposes. 1 a� (Applicant or Agent): Application Number . . . . . 12-00001147 Permit. . . MECHANICAL Additional desc . Permit Fee . . . . 66.00 Plan Check Fee 16.50 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 3/27/13 Qty Unit Charge, Per Extension. BASE FEE 15.00 2.00 9.0000 EA MECH FURNACE <=100K 18.00 2.00 16.5000 EA MECH B/C >3-15HP/>100K-500KBTU 33.00 ---------------------------------------------------------------------------- Special Notes and Comments HVAC CHANGE -OUT: REPLACE (1) 3 TON A/C UNIT & (1) 5 TON A/C UNIT. 2010 CODES. ---------------------------------------------- Other Fees . . . . . . . . . BLDG ----------------------------- STDS ADMIN (SB1473) 1.00 .Fee summary Charged ----------------- ---------- ---------- Paid Credited ---------- ---- Due - ----- Permit Fee Total 66.00 .00 .00 66.00 Plan Check Total 16.50 .00 .00 16.50 Other Fee Total 1.00 .00 00 1.00 Grand Total 83:.50 .00 .00 83.50 LQPERMIT Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-lR-ALT-HVAC Climate Zones 10 - 15 Site Address: Enforcement Agency: Date: Permit #: 79311 Tom Fazio La Quinta, CA 92253 City of La Quinta Sep 28, 2012 Duct insulation Conditioned Floor Equipment Type1 List Minimum Efficiency2 requirement Area Thermostat ❑ Package Unit ® Furnace ❑ Indoor Coil ® AFUE 78% ® SEER 13.0 ❑ COP ❑ HSPF ❑ R 6 (CZ 10-13) Served by system ® Setback If not already present, must be ® Condensing Unit [3EER [3 Resistance ❑R 8 (CZ 14-15) 1200 sf installed) ❑ Other 1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF-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-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-1R 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-4R forms: MECH-21 and (for split systems) MECH-25 • Condenser Coil and /or • Indoor Coil and /or CF-611 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: ❑ 1.'Duct system was documented to have been previously sealed and confirmed through HERS verification, or ❑ 2. Duct systems with less than 40 linear feet in unconditioned space, or ❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos ❑ 4. The system will not be Ducted'(ie.,Ductless,Mini-Split System)(Also Exempt,from ; Refrigerant Charge) h ❑ 2. New HVAC System Required Forms: u 1 E Y .Cut in or Changeout with - new ducts: (all new / f " -- CF-6R forms: MECH-04 MECH-20=HERS and (for split systems) MECH-22-HERS and ducti6g and all new MECH=25-HERS t CF-4R forms: MECH 20, and fors lits stems MECH-22 and MECH-25 ( P ) � �� equipment) iY �'! �, � \ � �� __ / �- �—� s � I %, .. � . For Split Systems: Duct leakage <6-percent; RC, CCA.>_ 350 CFM/ton, FWD_, TMAH, STMS, and either HSPP or PSPP. For Packaged Units: Duct leakage` < 6 percent ❑ 3. New Ducts with/or without Required Forms: Replacement . Includes replacing or installing all new ducting and/or outdoor condensing unit CF-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: Lisa Van Vlymen Signature: Lisa Van Vlymen Company: AIR EXPERTS AIR CONDITIONING-HEATING Date: Sep 28, 2012 Address: PO BOX 94 License: 725283 City/State/Zip: LA QUINTA / CA / 92247-0094 Phone: (760) 777-1724 Reg: 212-A0054247A-00000000-0000 Registration Date/Time: 2012/09/28 16:41:26 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 - 1S Site Address: Enforcement Agency: Date: Permit #: 79311 Tom Fazio ( System 2 ) La Quinta, CA 92253 City of La Quinta Sep 28, 2012 Duct insulation Conditioned Floor Equipment Typel List Minimum Efficiency2 requirement Area Thermostat ❑ Package Unit ® Furnace [3 Indoor Coil ® AFUE 78% ® SEER 13.0 ❑ COP [3HSPF 13 R 6 �� 10-13) Served by system ® Setback If not already present, must be ® Condensing Unit ❑ EER ❑ Resistance ❑ R 8 (CZ 14-1S) 2000 sf 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-611 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-611 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-611 forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS • Furnace CF-411 forms: MECH-21 and (for split systems) MECH-25 For Split Systems: Duct leakage.< 15 percent; RC, CCA <_ 300 CFM/ton (Minimum Air Flow Requirement), TMAH C..- Parka ed Units- P-WA leakage < 19 per-eeRt Exempted from duct leakage testing if: ❑ 1. Duct system was documented to have been previously sealed and confirmed through HERS verification, or ❑ 2. Duct systems with less than 40 linear feet in unconditioned space, or ❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos ❑ 4. The system will not be Ducted (ie1Ductless ,Mini-Split-System)-(Also Exempt from;Refrigerant Charge) ❑ 2. New HVAC System Required Forms: *' . Cut infor Changeout with; ` + 1' l �� CF 611 forms: MECH-04, MECH-2AERS, and (for split systems) MECH22-HERS, and new ducts: (all new ductirig and all new MECH-251 HERS 1 11 I _ '- + ,r"?41N 0,, CF-4R forms: MECH 20, and (for split systems) MECH-22, and MECH-25 equipment) �� /1 r: v .4I �t ✓ -- .- 7 e .+ . r!� °� For Split Systems: Duct leakage, c6 percent; RC, CCA >_ 350 CFM/ton; FWD, TMAH, STMS, and either HSPP or PSPP. For Packaged Units: Duct leakage�< 6 percent ❑ 3. New Ducts with/or without Required Forms: Replacement . Includes replacing or installing all new ducting and/or outdoor condensing unit CF-611 forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS and/or indoor coil and/or furnace. No or some CF-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: Paul Van Vlymen Signature: Paul Van Vlymen Company: AIR EXPERTS AIR CONDITIONING-HEATING Date: Sep 28, 2012 Address: PO BOX 94 License: 725283 City/State/Zip: LA QUINTA / CA / 92247-0094 Phone: (760) 777-1724 Reg: 212-A0054249A-00000000-0000 Registration Date/Time: 2012/09/28 16:43:55 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms July 2010 i # Cr .: ' ty of La Qurnta Building 8L Safety Division Permit # P.O. Box 1504,78-495 Calle Tampico .�` La..Quinta, CA 92253 -:(760) 777-7012 Building Permit' Application and Tracking Sheet Project Address: Owner's Name:. ' A P. Number Address: -7C7,3// ii`� 24 c) I Legal Description: Contractor. A14 City, ST, Zip: Lf', Q -- Telephone: ,st` Kill Kill Project Description: gn. 8- City, ST, Zip: A. 0v.N� Q4 r7 ZZ� � z r.' (v Telephone: W7122111.. � iml A) — State Lic. 4: i City Lic. #: �7 3 yJ Arch., Engr., Designer j Address: City., ST, Zip: Telephone:>. Construction Type- . Occupancy: State Lic. #: - ^�' :m ��:w��yuu� � Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: Sq. Ft.: #Stories: #Units: Telephone # of Contact Person: Estimated Value of Project �. _ Q i APPLICANT: DO NOT WRITE BELOW THIS UNE # Submittal Req'd'Rec'd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calm Reviewed, ready for corrections Plan Check Deposit. . TYuss Cales. Called Contact Person Plan Check Balance. Title 24 Calci. Plans picked up Construction _._._ Flood plain pinnT _Plans.resubmitted=------.—. Mechanical— Grading plan 2u Review, ready for correctionsfissue - — -- Electrical Subeontactor List '! Called Contact Person Plumbing Grant Deed Pians picked up S,M,I H.O.A. Approval Plans resubmitted Grading IM HOUSE:- '^' Review; ready for corrections/issue Developer Impact Fee Planning Approval. Called Contact Person A.I P.P. Pub. Wks. Appr ' Date of permit issue Schodl Fees Total Permit Fees INSTALLATION CERTIFICATE CF-6R-MECH-04 Space Conditioning Systems, Ducts and Fans (Page 1 of 2) Site Address: Enforcement Agency: Permit Number: 79311 Tom Fazio, La Quints CA 92253 (System 1) City of La Quinta 12-1147 Space Conditioning Systems Heating Equipment Equip Type (package- heat pump) CEC Certified Mfr. Name and Model Number ARI Reference Number -2 # of Identical Systems Efficiency (AFUE, etc.)1, 3 (>=CF -SR value)4 Duct Location (attic, crawl- space, etc.) Duct R -value Heating Load (kBtu/hr) Heating Capacity ' (kBtu/hr) Split Furnace MAYTAG PGC2TA100CVC1 ARI Reference Number2 1 80 AFUE Attic R-4.2 80 100 kBtu Split A/C , MAYTAG r CSA4131`036KA +etk-1 16 SEER 11 11EER7C� r,,Attie`: rR=4.2rj -,-60-y 5Tons J f y y .o! 4 ,, .F. ��'" `1, '"�.y„Y „".drF "` `"•fi '� F'� r., a l'I � 'ik: � f f, AV - e coonno cau►pmenr 1. Efficiency Dud Equip Type (package heat pump) ` CEC Certified Mfr.. Name and Model Number ARI Reference Number2 # of Identical Systems (SEER and EER) 1, 3 (>=CF -1R value)4 Location (attic, crawl- space, etc.) Dud R -value Cooling Load (kBtu/hr) Cooling Capacity (kBtu/hr) Split A/C , MAYTAG r CSA4131`036KA +etk-1 16 SEER 11 11EER7C� r,,Attie`: rR=4.2rj -,-60-y 5Tons J f y y .o! 4 ,, .F. ��'" `1, '"�.y„Y „".drF "` `"•fi '� F'� r., a l'I � 'ik: � f f, AV - e 1. J1 fJfUfeCL I? fICW LU115LfULUu11, see ruUMULes W JCdnOdrus aaDae 1.71-tl ano IaDle 1.51-0. ror DUCC cening airernarlve compliance. f 2. ARI Reference Number can be found by entering the equipment model number at http://www. aridirectory. orglari/ac. php# 3. Listed efficiency on this page must be greater than or equal ( ? ) to the value shown on the CF -IR form. 4. When CF -11Z is reference it is also applicable to the CF -1R, CF -IR -AA or CF -IR -ALT ,ALL BOXES MUST BE CHECKED TO BE A VALID FORM IN §110-§113: HVAC equipment Is certified by the California Energy Commission. ® §150(h): Heating and/or cooling loads calculated in accordance with ASHRAE, SMACNA, or ACCA. ® §150(i): Setback Thermostat on all applicable heating and/or cooling systems meet the requirements of §112(c). , ® §150(j)2: Pipe insulation for cooling system refrigerant suction, chilled water and brine lines meets -a> minimum requirements of Table 150-B and includes a vapor retardant or is enclosed entirely in conditioned space. >�t Reg: 212-A0054247A-M0400001A-0000 Registration Date/Time: 2012/10/16 20:05:29 2008 Residential Compliance Forms • t. a ;. HERS Provider: CalCERTS, inc'.;. August4.2009 "' INSTALLATION CERTIFICATE CF-6R-MECH-04 Space Conditioning Systems, Ducts and Fans (Page 2 of 2) Site Address: Enforcement Agency: Permit Number: 79311 Tom Fazio, La Quinta CA 92253 (System 1) City'of La Quint a 12-1147 Ducts and Fans §150(m): Duct and Fans ❑ 1. All air -distribution system ducts and plenums installed, sealed and insulated to meet the requirements of CMC Sections 601, 602, 603, 604, 605 and Standard 6-5; supply -air and return -air ducts and plenums are insulated to a minimum installed level of R-4.2 or enclosed entirely in conditioned space. Openings shall be sealed with mastic, tape or other duct -closure system that meets the applicable requirements of UL 181, UL 181A, or UL 181B or aerosol sealant that meets the requirements of UL 723. If mastic or tape is used to seal openings greater than 1/4 inch, the combination of mastic and either mesh or tape shall be used; and ❑ 1. Building cavities, support platforms for air handlers, and plenums defined or constructed with materials other than sealed sheet metal, duct board or flexible duct shall not be used for conveying conditioned air. Building cavities and support platforms may contain ducts. Ducts installed in cavities and support platforms shall not be compressed to cause reductions in the cross-sectional area of the d u cts. ❑ 2D. Joints and seams of duct systems and their components shall not be sealed with cloth back rubber adhesive duct tapes unless such tape is used in combination with mastic and draw bands. ❑ 7. Exhaust fan systems have back draft or automatic dampers. ❑ 8. Gravity ventilating systems serving conditioned space have either automatic or readily accessible,, manually operated dampers. , ❑ Protection of Insulation. Insulation shall be protected from damage, including that due to sunlight, moisture, equipment maintenance, and wind. Cellular foam insulation shall be protected as above or painted with a coating that'is water retardant and provides shielding from solar radiation that can cause degradation -of --the material. ❑ 10. Flexible ducts cannot have porous inner cores. fir+{ Z&O DECLARATION STATEMENT • I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. • I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized representative of the person responsible for construction (responsible person). • I certify that the installed features, materials, components, or manufactured devices identified on this certificate (the installation) conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the enforcement agency. • I reviewed a copy of the Certificate of Compliance (CF -111) form approved by the enforcement agency that identifies the specific' requirements for the installation. I certify that the requirements detailed on the CF -111 that apply to the installation have been met. • I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I. understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) Air Experts Air Conditioning Responsible Person's Name: Responsible Person's Signature: Paul Van Vlymen Paul Van Vlymen CSLB License: 725283 Date Signed: 10/4/2012 Position With Company (Title): Reg: 212-A0054247A-M0400001A-0000 Registration Date/Time: 2012/10/16 20:05:29 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS Duct Leakage Test — Existing Duct System (Page 1 of 2) Site Address: Enforcement Agency: Permit Number: 79311 Tom Fazio, La Quinta CA 92253 (System 1) City of La Quinta 12-1147 - 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 dwellingsto 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. [3 Reg: 212-A0054247A-M2100001A-0000 Registration Date/Time: 2012/10/16 20:06:32 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 1. Measured leakage less than 15% of fan flow ❑ 2. Measured leakage to outside less than 10% of Fan Flow ❑ 3. Reduce leakage by 60% and conduct smoke and fix all leaks i ® 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 nom nal,.Fen Flow using one of theme following,three.calculation,methods. ✓ ❑ Cooling,rsyste'm method: Size of condenser in Tons -,`x400'== CFM , ✓ ®Heating system method/]:i21.7Jj x d80 Output Capacityyi�n(Thous nds of Btu/hr 1736 CFM �, ✓ ❑ Measured systemeairflow using RA3.3 airflow ,testfprocedures: jr CFM r .� Option+caused then:" rrm� '+;f d.-.+:'`rwa! ^ �:.x"'f ..41 1 Allowed leakage'= FanrAirflow a 1736•='x 0.15= +- 260:4 CFM.' , Actual Leakage = 538 CFM � . Pass if Actual Leakage is less than Allowed leakage p Pass Fail Option 2 used then: 2 Allowed leakage = Fan Airflow 1736 x 0.10 = 173.6 CFM Actual Leakage to outside = CFM Pass if Actual leakage to outside is less than Allowed leakage 0 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 1 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 pq Pass Fail Reg: 212-A0054247A-M2100001A-0000 Registration Date/Time: 2012/10/16 20:06:32 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: Enforcement Agency: Permit Number: 79311 Tom Fazio, La Quinta CA 92253 (System 1) City of La Quinta 1 12-1147 ® 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:treturn register boots -mustrbe,sealedrtoTthe drywall_,if "smoke,testris�utilized=for compliance "* - - , o y - applies to,duct leakage compliance option 3 �(leakage`reduction 6y60 /o)randfoption14 (fix all kcessible leaks) described above ! � ,r ® New duct installations cannotsu M building cavities as plenums or platform returns in, lieu of•ducts ® Masticdand;draw'bands must,be�used. imcombination wiKcloth backed,rubber1adheslvefduct tape,�to seal leaks at all riew 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 ori 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 -SR that apply to the installation have been met. . I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. 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) Air Experts Air Conditioning Responsible Person's Name: Responsible Person's Signature: Paul Van Vlymen Paul Van Vlymen CSLB License: 725283 Date Signed: 10/4/2012 Position With Company (Title): Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? I7 Yes p No Reg: 212-A0054247A-M2100001A-0000 Registration Date/Time: 2012/10/16 20:06:32 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE* CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 5) Site Address: Enforcement Agency: Permit Number: 79311 Tom Fazio, La Quinta CA 92253 1 City of La Quinta 12-1147 Note: If installation of a Charge Indicator Display (CID) is utilized as an alternative to refrigerant charge verification for compliance, a MECH-24 Certificate (instead of this MECH-25 Certificate) should be used to demonstrate compliance with the refrigerant charge verification requirement. TMAH and STMS are not required for compliance, when a CID is utilized for compliance. As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional form(s) for any additional systems in the dwelling as applicable. Temperature Measurement Access Holes (TMAH).and Saturation Temperature Measurement Sensors (STMS) Procedures for installing TMAH are specified in Reference Residential Appendix RA3.2. If refrigerant charge verification is required for compliance, TMAH are also required for compliance. STMS are only required for completely new or replacement space -conditioning systems that utilize prescriptive compliance method. TMAH - Access Holes in SUDoly and Return Plenums of Air Handler System Name or Identification/Tag System 1 " { The sensor is factory installed or�field-installed according to manufacturers 3 System Location or Area Served 413 o J MASTER C t Director. t _ - i i f`#� In7 BEDROOM The sensor"wirejs terminated with a standard mini plug suitable for connection'to'al�- 4 1 ® Yes ❑ No 5/16 inch (8 mm) access hole upstream of evaporative coil in the return plenum and and the HERS rater without changing the airflow through the condenser coil labeled according to Figure in Section RA3.2.2.2.2. 2 ® Yes ❑ No 5/16 inch (8 mm) access hole downstream of evaporative coil in the supply plenum ✓ ® N/A ✓ ❑ Pass ✓ ❑ Fail and labeled according to Figure in Section RA3.2.2.2.2. Yes to 1 and' 2 is a pass. Enter Pass or Fail ✓ ®'Pass I ✓ ❑Fail STMS - SensorJ"on the Evauorator Coil System Name or Identification/Tag,j I .% f System 1 I I J f " { The sensor is factory installed or�field-installed according to manufacturers 3 ['3 Yes 413 o J specifications, or is installed by methods/specifications approved bythe Executive.1. C t Director. t _ - i i f`#� In7 The sensor"wirejs terminated with a standard mini plug suitable for connection'to'al�- 4 ❑ 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 5 1 _ .❑.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 ✓ ® N/A ✓ ❑ Pass ✓ ❑ Fail applicable. Otherwise enter Pass or Fail STMS - Sensor on the Condenser Coil System Name or Identification/Tag System 1 The sensor is factory installed, or field installed according to manufacturer's 6 ❑ Yes ❑ No specifications, or is installed by methods/specifications approved by the Executive Director. The sensor wire is terminated with a standard mini plug suitable for connection to a 7 ❑ Yes ❑ No digital thermometer. The sensor mini plug is accessible to the installing technician and the HERS rater without changing the airflow through the condenser coil 8 ❑ Yes ❑ No 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 ✓ _®N/A ✓ (3 Pass ✓ [3 Fail applicable. Otherwise enter Pass or Fail Reg: 212-A0054247A-M2500001A-0000 Registration Date/Time: 2012/10/16 20:08:45 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-2S-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of S) Site Address: Enforcement Agency: Permit Number: 79311 Tom Fazio, La Quinta CA 92253 City of La Quinta 12-1147 Standard Charge Measurement Procedure (for use if outdoor air dry-bulb is above 55°F) Procedures for determining Refrigerant Charge using the Standard Charge Measurement Procedure are available in Reference Residential Appendix RA3:2. As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional form(s) for " any additional systems in the dwelling as applicable. • The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure. • The system must meet minimum airflow requirements as prerequisite for a valid refrigerant charge test. • If outdoor air dry-bulb is 55°F or below, the installer must use the Alternate Charge Measurement Procedure. Space Conditioning Systems System Name or Identification/Tag ' System 1 (must be re -calibrated monthly) _ System Location or Area Served MASTER BEDROOM 9/6/12 P'..,X ',(must be re -calibrated monthly) Outdoor Unit Serial # CSD120403173 Outdoor Unit Make MAYTAG Outdoor Unit Model CSA4BF036KA , Nominal Cooling Capacity Btu/hr 36000 Date of Verification I 10/4/12 6,0IIUICIL1U11 UI VIQgIIUbUG if bLIFURIC"Lb Date of Refrigerant Gauge CalibratioI n 9/6/12 (must be re -calibrated monthly) _ Supply (evaporator leaving),air dry,bulb Date of Thermocouple, Calibration 771 9/6/12 P'..,X ',(must be re -calibrated monthly) Ik v...... cu I cu.lice awl ca: -4:9-j l a -f '0 tem 1 �'�, tL,M� �^�"" � '"'' --• � `, � 'i .w9��v"�` •,+n4 ♦4T- •"f.!� AIF wy,� X! •'-tea �'�,y,S.{l,+ Artd,,`'#f!r T',;'., System Name or Identification/Tag F :t t _rrr. .Art Sys aC Supply (evaporator leaving),air dry,bulb temperature (Tsupply, db) System Name or Identification/Tag F :t t _rrr. .Art Sys aC Supply (evaporator leaving),air dry,bulb temperature (Tsupply, db) Return (evaporator entering) air dry-bulb 86 temperature (Treturn, db) ' Return (evaporator entering) air wet -bulb 63 temperature (Treturn, wb) Evaporator saturation temperature. 54 (Tevaporator,sat) Condensor saturation temperature 106 (Tcondensor, sat) Suction line temperature (Tsuction) 71 Liquid Line Temperature (Tliquid) 98 Condenser (entering) air dry-bulb 96 temperature (Tcondenser, db) Reg: 212-A0054247A-M2500001A-0000 Registration Date/Time: 2012/10/16 20:08:45 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-611-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5) Site Address:Enforcement Agency: Permit Number: 79311 Tom Fazio, La Quinta CA 92253 City of La Quinta 12-1147 Minimum Airflow Requirement Temperature Split Method Calculations for determining Minimum Airflow Requirement for Refrigerant Charge Verification. The temperature split method is specified in Reference Residential Appendix RA3.2. System Name or Identification/Tag System 1 Calculate: Actual Temperature Split = Treturn, 26.00 db - Tsupply, db Target Temperature Split from Table RA3.2-3 24 using Treturn, wb and Treturn, db Calculate difference: Actual Temperature Split - 2 Target Temperature Split = Passes if difference is between -3°F and +3°F or, - upon remeasurement, if between -30F and PASS -100°F Enter Pass or Fail Note: Temperature Split Method Calculation is not necessary if actual Cooling Coil Airflow is verified using one of the airflow measurement procedures specified in Reference Residential Appendix RA3.3. 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) g System Name`or Identification/Ta77 System 1' Y+, Y j .f a.; .. .. 11 Calculated Minimum Airflow qCFM ( ) '*• Tek �.. _ �'' J .,k y 'lri' #A i'`.i•Lt l - -' '�. .1 Measured Airflow using'RA3.3 procedures (CFM) : l r�• Fr Passes if measured airflow is greater than or, equal to the calculated minimum airflow requirement.'' ' Enter Pass or Fail t 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 -5°F and +5°F Enter Pass or Fail Reg: 212-A0054247A-M2500001A-0000 Registration Date/Time: 2012/10/16 20:08:45 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-611-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5) Site Address: Enforcement Agency: Permit Number: 79311 Tom Fazio, La Quinta CA 92253 1 City of La Quinta 12-1147 Subcooling Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag System 1 Calculate: Actual Subcooling = 8.0 Tcondenser, sat - Tliquid Target Subcooling specified by manufacturer .8 Calculate difference: 0 Actual Subcooling - Target Subcooling = System passes if difference is between -3°F and +3°F PASS �I U '� y� Y 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.= i 17.0 Tsuction - Tevaporator, sat Enter allowable superheat range from manufacturer's specifications (or use range 17 between 4°F and 250F if manufacturer's specification is not available) System passes if actual`superheat is-wit�`h�imthe - allowable superheat range r ' f � PASS �I U '� y� Y of " Pass or, .0 ,Enter ttt • �...` jj,(/p��(,+ .+q]pj\iy `y '�.,. ,i Y -.y . / 1 `' .. '^ � � }.w F '''... ct • .. ',tom -r .. � :..<Fb r ..-� - FFF •X Reg: 212-A0054247A-M2500001A-0000 Registration Date/Time: 2012/10/16 20:08:45 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5; Site Address: Enforcement Agency: Permit Number: 79311 Tom Fazio, La Quinta CA 92253 1 City of La Quinta 12-1147 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: 725283 Date Signed: 10/4/2012 Position With Company (Title): System meets all refrigerant charge and airflow Name of TPQCP (if applicable): Control Program (TPQCP)? ❑ Yes ❑ No . requirements. PASS Enter Pass or Fail {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 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 -SR that apply to the installation have been met. . I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. I will ensure that all Installation Certificates will come from a HERS provider data registry for multiDle orientation alternatives. and beoinnino October 1. 2n10_ fnr all Inw-rico rccirlantial hididinnc Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) Air Experts Air Conditioning Responsible Person's Name: Responsible Person's Signature: Paul Van Vlymen Paul Van Vlymen CSLB License: 725283 Date Signed: 10/4/2012 Position With Company (Title): Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? ❑ Yes ❑ No . Reg: 212-A0054247A-M2500001A-0000 Registration Date/Time: 2012/10/16 20:08:45 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms August 2009 r CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4111-MECH-21 Duct Leakage Test — Existing Duct System (Page 1 of 2) Site Address: Enforcement Agency: Permit Number: 79311 Tom Fazio, La Quinta CA 92253 (System 1) City of La Quinta 12-1147 Enter the Duct System Name or Identification/Tag: System 1 of 2 Enter the Duct System Location or Area Served: Masterbedroom 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 - existinq duct system Select one compliance method from the following four choices. , ❑ 1. Measured leakage less than 15% of fan flow ❑ 2. Measured leakage to outside less than 10% of Fan Flow i ❑ 3. Reduce leakage by 60% and conduct smoke and fix all leaks a ® 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 nominalrFan;.Flow using one, of theme;following,three,calculation,methods. ✓ ❑ Cooling system method: Size of condenser in Tons I i 400 -- 4 CFM N,: ✓ ® Heating system method: 21.7 x iiSO ` Output CapacityAin&housjands of Btu/hr = 1736 CFM',{ tp ✓ 13 Measured Il,� system' airflow using RA3.3'airflow,test,•procedures: _CFM i 1 �• �' Option'1Jused then: 4.. r ..•. h'a ' .. "' 1 Allowed leakage =°Fan Flow 1736— x 0.15 — 260.4 CFM , ,-- - Actual Leakage = S38 CFM _ Pass if Leakage Actual is less than Allowed Pass Fail Option 2 used then: 2 Allowed leakage =.Fan Flow s 1736 x 0.10 = 173.6 CFM Actual Leakage to outside = _ CFM Pass if Leakage Actual is less than Allowed Pass Fail Option 3 used then: Initial leakage prior to start of work = _ CFM Final leakage after sealing all accessible leaks using smoke test = _ CFM 3 Initial leakage _ - Final leakage _ = Leakage reduction _ CFM ((Leakage reduction _ / Initial leakage x 100% _ % Reduction Pass if %Reduction >= 60% Pass rl 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 ImPass p Fail Reg: 212-A0054247A-M2100001A-M21A Registration Date/Time: 2012/10/17 14:21:50 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 CERTIFICATE OF FIELD VERIFICATION 8t DIAGNOSTIC TESTING CF-411-MECH-21 Duct Leakage Test - Existing Duct System (Page 2 of 2) Site Address: Enforcement Agency: Permit Number: 79311 Tom Fazio, La Quinta CA 92253 (System 1) City of La Quinta 12-1147 ® 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-tFie closed position during duct leakage testing. ® All supply�andsretu,rn register bootsmustlbe,sealed-tosthe dry,walla,if}smokertest;isrutilizedrfor compliance - applies �to�duct leakage compliancesoption 3 (leakage 6eductioh by 60%)"'and(optlon`(-4 (fix all accessible leaks) d� scribed abov� •� ® New duct installations cannot,utlllze;building cavities as plenums or: platform returns-,in,lieof ductsw ® Mastic andrde5w bands,must'6e used•in combinationwith':cloth backed-rbberjadhsivetp leaks at all new duct connections. DECLARATION STATEMENT' . I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. . I am the certified HERS rater who performed the verification services identified and reported on this certificate (responsible rater). . The installed feature, material, component, or manufactured device requiring HERS verification that is identified on this certificate (the installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified on the Certificate(s) of Compliance (CF -SR) approved by the local enforcement agency. . The information reported on applicable sections of the Installation Certificate(s) (CF -611), signed and submitted by the person(s) responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -111) approved by the enforcement aaencv. Builder or Installer information as shown on the Installation Certificate (CF -6R) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) AIR EXPERTS AIR CONDITIONING -HEATING Responsible Person's Name: CSLB License: Lisa Van Vlymen 1725283 HERS Provider Data Registry Information Sample Group # (if applicable): N/A13not-tested/verified ®tested/verified dwelling dwelling in la HERS sample group HERS Rater Information CalCERTS Certificate # CCI -1798695596 HERS Rater Company Name: Air Solutions of the Desert Responsible Rater's Name: Responsible Rater's Signature: Walter W Nellis. Walter W Nellis Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 10/4/2012 CC2004361 Reg: 212-A0054247A-M2100001A-M21A Registration Date/Time: 2012/10/17 14:21:50 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 5) Site Address: Enforcement Agency: Permit Number: 79311 Tom Fazio, La Quinta CA 92253 City of La Quinta 12-1147 Note: If installation of a Charge Indicator Display (CID) is utilized as an alternative to refrigerant charge verification for compliance, a MECH-24 Certificate (instead of this MECH-25 Certificate) should be used to demonstrate compliance with the refrigerant charge verification requirement. TMAH and STMS are not required for compliance, when a CID is utilized for compliance. As many as 4 systems in the dwelling can be documented for compliance using this form. *Attach an additional form(s) for any additional systems in the dwelling as applicable. Temperature Measurement Access Holes (TMAH) and Saturation Temperature Measurement Sensors (STMS) Procedures for installing TMAH are specified in Reference Residential Appendix RA3.2. If refrigerant charge verification is required for compliance, TMAH are also required for compliance. STMS are only required for completely new or replacement space -conditioning systems that utilize prescriptive compliance method. TMAH - Access Holes in SUDDIV and Return Plenums of Air Handler System Name or Identification/Tag 3 System 1 of 2 ❑ No 0 The sensor is factory installed, or field'installed according to manufacturer's specifications, or is installed by methods/specifications approved,by the Executive The sensor is factory installed, or field installed according to manufacturer's System Location or Area Served ❑ Yes master bedroom specifications, or is installed by methods/specifications approved by the Executive ,4 r/ ! 1 ® Yes ❑ No 5/16 inch (8 mm) access hole upstream of evaporative coil in the return plenum and labeled according to Figure in Section RA3.2.2.2.2. 2 ® Yes ❑ No ' 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 Faill ✓ ® Pass ✓ ❑Fail STMS - Sensorown th Evaporator, Coil] System Name or Identification/,Tag/ ; ./ r System'1 of 2 3 ❑ Yes ❑ No 0 The sensor is factory installed, or field'installed according to manufacturer's specifications, or is installed by methods/specifications approved,by the Executive The sensor is factory installed, or field installed according to manufacturer's 6 ❑ Yes Director. .'� � � �! •1 � specifications, or is installed by methods/specifications approved by the Executive ,4 r/ ! f A_1 :r.} A I { sr�].� /t" Director. `-,vOr-f - ', %._ %_-' The senso"r.wire'is terminated -with a standard mini plug suitable for connection.to a�" 4 ❑ Yes [3 No digital thermometer. The sensor mini plug is accessible to the installing technician digital thermometer. The sensor mini plug is accessible to the installing technician and the HERS rater without changing the airflow through the condenser coil 5 '"'❑Yes t ❑ No. When attached to a digital thermometer, the sensor provides an indication of the When attached to a digital thermometer, the sensor provides an indication of the s aturation temperature of the coil. Yes to 3, 4, and 5 is a pass. Enter N/A if STMS are not ✓ ®N/A ✓ ❑Pass ✓ ❑Fail applicable. Otherwise enter Pass or Fail applicable. Otherwise enter Pass or Fail STMS - Sensor on the Condenser Coil System Name or Identification/Tag I System 1 of 2 The sensor is factory installed, or field installed according to manufacturer's 6 ❑ Yes ❑ No specifications, or is installed by methods/specifications approved by the Executive Director. The sensor wire is terminated with a standard mini plug suitable for connection to a 7 ❑ Yes ❑ No digital thermometer. The sensor mini plug is accessible to the installing technician and the HERS rater without changing the airflow through the condenser coil 8 ❑ Yes ❑ No When attached to a digital thermometer, the sensor provides an indication of the saturation temperature of the coil. Yes to 6, 7, and 8 is a pass. Enter N/A if STMS are not _F ✓ ®N/A ✓ p Pass ✓ [3 Fail applicable. Otherwise enter Pass or Fail 0 Reg: 212-A0054247A-M2500001A-M25A Registration Date/Time: 2012/10/17 14:26:21 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5) Site Address: Enforcement Agency: Permit Number: 79311 Tom Fazio, La Quinta CA 92253 City of La Quinta 12-1147 Standard Charge Measurement Procedure (for use if outdoor air dry-bulb is above 55°F) Procedures for determining Refrigerant Charge using the Standard Charge Measurement Procedure are available in Reference Residential Appendix RA3.2. As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional form(s) for any additional systems in the dwelling as applicable. • The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure. • The system must meet minimum airflow requirements as prerequisite for a valid refrigerant charge test. • If outdoor air dry-bulb is 55°F or below, the installer must use the Alternate Charge Measurement Procedure. Space Conditioning Svstems System Name or Identification/Tag System 1 of 2 (must be re -calibrated monthly) System Location or Area Served master bedroom 9/6/12 (must be re -calibrated monthly) Outdoor Unit Serial # CSD120403173 - Outdoor Unit Make Maytag Outdoor Unit Model, CSA4BF036KA Nominal Cooling Capacity Btu/hr 36000 Date of Verification °( 10/4/12 V0111J1 CILIU11 UI L/IGy11V5LI9. anSLrumCnL5 Date of Refrigerant Gauge Calibration 9/6/12 (must be re -calibrated monthly) Date of Thermocouple,Calibration 9/6/12 (must be re -calibrated monthly) Supply (evaporator leaving)'air dry -bulbi' 60; 19=OMUICY,;ICIIILJCFaLU1Cb`t' rJ / f`•.J " `J1' System Name or Identification/Tag SystemYT Supply (evaporator leaving)'air dry -bulbi' 60; - temperature (Tsupply, db) ,) Return (evaporator entering) air dry-bulb temperature (Treturn, tem ( p return, db) Return (evaporator entering) air wet -bulb 63 temperature (Treturn, wb) Evaporator saturation temperature 54 (Tevaporator, sat) Condensor saturation temperature 106 (Tcondensor, sat) Suction line temperature (Tsuction) 71 Liquid Line Temperature (Tliquid) 98 Condenser (entering) air dry-bulb 96 temperature (Tcondenser, db) Reg: 212-A0054247A-M2500001A-M25A Registration Date/Time: 2012/10/17 14:26:21 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 0 INSTALLATION CERTIFICATE CF-411-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5) Site Address: Enforcement Agency: Permit Number: 79311 Tom Fazio, La Quinta CA 92253 City of La Quinta 12-1147 Minimum Airflow Requirement Temperature Split Method Calculations for determining Minimum Airflow Requirement for Refrigerant Charge Verification. The temperature split method is specified in Reference Residential Appendix RA3.2. System Name or Identification/Tag System 1 of 2 ti Calculate: Actual Temperature Split = Treturn, 26.00 db - Tsupply, db Target Temperature Split from Table RA3.2-3 24 using Treturn, wb and Treturn, db Calculate difference: Actual Temperature Split - 2 Target Temperature Split = Passes if difference is between -4°F and +4°F or, upon remeasurement, if between -4°F and PASS -100°F Enter Pass or Fail Note: Temperature Split Method Calculation is not necessary if actual Cooling Coil Airflow is verified using one of the airflow measurement procedures specified in Reference Residential Appendix RA3.3. 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 a y .��^ • /T 9 f , 6. -I�• �i� . rr r Calculated Minimum Airflow Requirement (CFM) l I A" t Measured''Airflow;i�ng RA3:3 p ocedu es (CFM) I'" M •M j'r:. Passes if measured airflow is greater than or equal to the calculated minimum airflow requirements Enter Pass or Fail Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for fixed orifice metering device systems System Name or Identification/Tag Calculate: Actual Superheat = Tsuction - Tevaporator, sat Target Superheat from Table RA3.2-2 using Treturn, wb and Tcondenser, db Calculate difference: Actual Superheat - Target Superheat = System passes if difference is between -6°F and +6°F Enter Pass or Fail Reg: 212-A0054247A-M2500001A-M25A Registration Date/Time: 2012/10/17 14:26:21 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE . CF-411-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5) Site Address: Enforcement Agency: Permit Number: 79311 Tom. Fazio, La Quinta CA 92253 City of La Quinta 12-1147 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 of 2 Calculate: Actual Subcooling = 8.0 Tcondenser, sat - Tliquid Target Subcooling specified by manufacturer 8 Calculate difference: 0 Actual Subcooling - Target Subcooling = System passes if difference is between -4°F and +4°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 of,2 Calculate: Actual Superheat = f 17.0 Tsuction - Tevaporator, sat ^ Enter allowable superheat range from manufacturer's specifications (or use.range 17 between 3°F and 26°F if manufacturer's specification is not available) System passeslf actual superheat is "within the allowable superheat range �`/ /A�� -, f. PASS ,o -Enter Pass or Fail 1 jfXj ! Iry � • aJ%' ,3'. Y :�,: ,�,.'w�y # .. � CSR"7 Cad?..; y:?Y-n � � ��I"��_.. f � Reg: 212-A0054247A-M2500001A-M25A Registration Date/Time: 2012/10/17 14:26:21 HERS Provider:.Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE - CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5) Site Address: Enforcement Agency: Permit Number: 79311 Tom Fazio, La Quinta CA 92253 City of La Quinta 1271147 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 of 2 725283 HERS Provider Data Registry Information Sample Group # (if applicable): N/A❑ System meets all refrigerant charge and airflow not-tested/verified dwelling in la HERS sample group requirements. PASS Air Solutions of the Desert Responsible Rater's Name: Responsible Rater's Signature: Enter Pass or Fail Walter W Nellis Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 10/4/2012 CC2004361 3 4 DECLARATION STATEMENTi- f . I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. . I am the certified HERS rater who performed the verification services identified and reported on this certificate (responsible rater). . The installed feature, material, component, or manufactured device requiring HERS verification that is identified on this certificate (the installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified' on the Certificates) of Compliance (CF -111) approved by the local enforcement agency. . The information reported on applicable sections of the Installation Certificate(s) (CF -6R), signed and submitted by the person(s) responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -111) approved by the enforcement aaencv. Builder or Installer information as shown on the Installation Certificate (CF -6111) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) AIR EXPERTS AIR CONDITIONING -HEATING Responsible Person's Name: CSLB License: Lisa Van Vlymen 725283 HERS Provider Data Registry Information Sample Group # (if applicable): N/A❑ ®tested/verified dwelling not-tested/verified dwelling in la HERS sample group HERS Rater Information CalCERTS Certificate # CCI-179869SS96 HERS Rater Company Name: Air Solutions of the Desert Responsible Rater's Name: Responsible Rater's Signature: Walter W Nellis Walter W Nellis Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 10/4/2012 CC2004361 Reg: 212-A0054247A-M2500001A-M25A Registration Date/Time: 2012/10/17 14:26:21 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 1 • y . INSTALLATION CERTIFICATE CF-6R-MECH-04 ARI Reference Number2 Space Conditioning Systems, Ducts and Fans, (Page 1 of 2) Duct Location (attic, crawl- space, etc.) Site -Address: 79311 Tom Fazio ( System 2 ), La Quinta CA 92253' Enforcement Agency:. Permit Number: Split Furnace (System 1) City of La Quinta 12-1147 80 AFUE Space Conditioning Systems Heating Equipment ' Equip Type (package- heat pump) CEC Certified Mfr. Name and Model Number ARI Reference Number2 # of Identical Systems Efficiency (AFUE, etc.)1, 3 (>=CF -1R value)4 Duct Location (attic, crawl- space, etc.) Duct R -value Heating Load (kBtu/hr) Heating Capacity (kBtu/hr) Split Furnace MAYTAG PGC2TA300CVC1 1 80 AFUE Attic R-4.2 80 100 kBtu Type. _ (package -"t+- ARI # of and EER) 1, 3 (attic, . crawl- Cooling Cooling heat CEC Certified Mfr. Name Reference Identical (>=CF -SR space, Dud Load Capacity pump). and Model Number} Number2 Systems value)4 etc.) R -value (kBtu/hr) (kBtu/hr) Split -,;�MAYTAG r►J � 16 -SEER'+ f ` � . &,-- //''' A/C _ CSD120608033 493985V 1 ,13 EERY Attic: _ R-4.2 _ fr 60 _. 5 Tons cooung tquipmenr 1. lr project IS new construction, see rOOtnores to standards ladle 151-tf and !able 151-C ror duct ceiling alternative compliance. I 2. ARI Reference Number can be found by entering the equipment model number at http://www.aridirectory.orglarilac.php# 3. Listed efficiency on this page must be greater than or equal ( ? ) to the value shown on the CF -IR form. 4. When CF -IR is reference it is also applicable to the CF -1R, CF -IR -AA or CF -IR -ALT ALL BOXES MUST BE CHECKED TO BE A VALID FORM ® §110-§113: HVAC equipment is certified by the California Energy Commission. ® §150(h): Heating and/or cooling loads calculated in accordance with ASHRAE, SMACNA, or ACCA. ® §150(i): Setback Thermostat on all applicable heating and/or cooling systems meet the requirements of §112(c). ® §150U)2: Pipe insulation for cooling system refrigerant suction, chilled water and brine lines meets minimum requirements of Table 150-B and includes a vapor retardant or is enclosed entirely in conditioned space. 0 Reg: 212-A0054249A-M0400001A-0000 Registration Date/Time: 2012/10/16 20:17:32 HERS Provider:. CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 Efficiency Dud Equip (SEER Location Type. _ (package -"t+- ARI # of and EER) 1, 3 (attic, . crawl- Cooling Cooling heat CEC Certified Mfr. Name Reference Identical (>=CF -SR space, Dud Load Capacity pump). and Model Number} Number2 Systems value)4 etc.) R -value (kBtu/hr) (kBtu/hr) Split -,;�MAYTAG r►J � 16 -SEER'+ f ` � . &,-- //''' A/C _ CSD120608033 493985V 1 ,13 EERY Attic: _ R-4.2 _ fr 60 _. 5 Tons 7 710-r' f�,i��r1' yJ/'�Rrwr 1. lr project IS new construction, see rOOtnores to standards ladle 151-tf and !able 151-C ror duct ceiling alternative compliance. I 2. ARI Reference Number can be found by entering the equipment model number at http://www.aridirectory.orglarilac.php# 3. Listed efficiency on this page must be greater than or equal ( ? ) to the value shown on the CF -IR form. 4. When CF -IR is reference it is also applicable to the CF -1R, CF -IR -AA or CF -IR -ALT ALL BOXES MUST BE CHECKED TO BE A VALID FORM ® §110-§113: HVAC equipment is certified by the California Energy Commission. ® §150(h): Heating and/or cooling loads calculated in accordance with ASHRAE, SMACNA, or ACCA. ® §150(i): Setback Thermostat on all applicable heating and/or cooling systems meet the requirements of §112(c). ® §150U)2: Pipe insulation for cooling system refrigerant suction, chilled water and brine lines meets minimum requirements of Table 150-B and includes a vapor retardant or is enclosed entirely in conditioned space. 0 Reg: 212-A0054249A-M0400001A-0000 Registration Date/Time: 2012/10/16 20:17:32 HERS Provider:. CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-04 Space Conditioning Systems, Ducts and Fans (Page 2 of 2) Site Address: 79311 Tom Fazio ( System 2 ), La Quinta CA 92253 Enforcement Agency: Permit Number: (System 1) City of La Quinta 12-1147 Ducts and Fans §150(m): Duct and Fans ❑ 1. All air -distribution system ducts and plenums installed, sealed and insulated to meet the requirements of CMC Sections 601, 602, 603, 604, 605 and Standard 6-5; supply -air and return -air ducts and plenums are insulated to a minimum installed level of R-4.2 or enclosed entirely in conditioned space. Openings shall be sealed with mastic, tape or other duct -closure system that meets the applicable requirements of UL 181, UL 181A, or UL 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 ❑ 1. Building cavities, support platforms for air handlers, and plenums defined or constructed with materials other than sealed sheet metal, duct board or flexible duct shall not be used for conveying conditioned air. Building cavities and support platforms may contain ducts. Ducts installed in cavities and support platforms shall not be compressed to cause reductions in the cross-sectional area of the ducts. ❑ 2D. Joints and seams of duct systems and their components shall not be sealed with cloth back rubber adhesive duct tapes unless such tape is used in combination with mastic and draw bands. ❑ 7. Exhaust fan systems,have back draft or automatic dampers. ❑ 8. Gravity ventilating systems serving conditioned space have either automatic or readily accessible, manually operated dampers. ❑ Protection of Insulation. Insulation shall be protected from damage, including that due to sunlight, moisture, equipment maintenance, and wind. Cellular foam insulation shall be protected as above or painted with•a coating that`is water retardant and provides shielding from solar radiation that can cause degradation of the material. ❑ 10. Flexible ducts cannot have.ppoorou;slin_ne, 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 -111) form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF -111 that apply to the installation have been met. . I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) Air Experts Air Conditioning Responsible Person's Name: Responsible Person's Signature: Paul Van Vlymen Paul Van Vlymen CSLB License: 725283 Date Signed: 10/4/2012 Position With Company (Title): Reg: 212-A0054249A-M0400001A-0000 Registration Date/Time: 2012/10/16 20:17:32 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS Duct Leakage Test — Existing Duct System (Page 1 of 2) Site Address: 79311 Tom Fazio ( System 2 ), La Quinta CA 92253 Enforcement Agency: Permit Number: (System 1) City of La Quinta 12-1147 Enter the Duct System Name or Identification/Tag: System 1 Enter the Duct System Location or Area Served: LIVING AREA Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the dwelling. This installation certificate is required for compliance for alterations and additions in existing dwellings to space conditioning systems and duct systems. Note: For existing dwellings, a completely new or replacement duct system can also include existing parts of the original duct system (e.g., register boots, air handler, coil, plenums, etc.) if those parts are accessible and they can be sealed. For a completely new or replacement duct system installed in an existing dwelling, use the Installation Certificate titled 'Duct Leakage Test - Completely New or Replacement Duct System. " Duct Leakage Diagnostic Test - existing duct system Select one compliance method from the following four choices. [3 Reg: 212-A0054249A-M2100001A-0000 Registration Date/Time: 2012/10/16 21:24:52 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 1. Measured leakage less than 15% of fan flow ❑ 2. Measured leakage to outside less than 10% of Fan Flow ❑ 3. Reduce leakage by. 60% and conduct smoke and fix all leaks ® 4. Fix all accessible leaks using smoke and HERS rater verify Note: (One of Options 1, 2 or 3 must be attempted„before utilizing Option M4.) Determine` nominal Fan Flow using one of the following three calculation methods. t ►/ ✓ ® Cooling•system method: Size of condenser in Tons r 5 x 400 =! 2000 CF M ✓ 13 T Heating system method: 21.7 x Output Capacity in Thousands'of Btu/hr = _CFM ❑ Measured system airflow usmg'RA3.3 airflow test procedures:°” CFM` mm Option 1 used then: ?44 . A- v, , ,.... 1 Allowed leakage = Fan Airflow 2000 x 0.15 = 300 CFM Act ual'Leakage = 613 CFM - { • Pass if Actual Leakage is less than Allowed leakage Pass ❑ Fail Option 2 used then: , i 2 Allowed leakage = Fan Airflow 2000 x 0.10 = 200 CFM Actual Leakage to outside = i CFM Pass if Actual leakage to outside is less than Allowed leakage Pass 0 Fail Option 3 used then: Initial leakage prior to start of work = _ CFM Final leakage after sealing all accessible leaks using smoke test = _ CFM 3 Initial leakage_- Final leakage _ = Leakage reduction CFM ((Leakage reduction _ / Initial leakage ) x 100% _ % Reduction Pass if % Reduction >= 60% Pass o 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 IM Pass Q Fail Reg: 212-A0054249A-M2100001A-0000 Registration Date/Time: 2012/10/16 21:24:52 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-6111-MECH-2I-HERS Duct Leakage Test — Existing Duct System (Page 2 of 2) Site Address: 79311 Tom Fazio ( System 2 ), La Quinta CA 92253 Enforcement Agency: Permit Number: (System 1) City of La Quinta . 12-1147 ® Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off during duct leakage testing. CFI OA ducts that utilize controlled motorized dampers, that open only when OA ventilation is required to meet ASHRAE Standard 62.2, and close when OA ventilation is not required, may be configured to the closed position during duct leakage testing. ® All supply and return register boots, must be�seaed to the drywall if smoke test is utilized for1compliance ' — applies?to duct leakage compliance option:3 (leakage reduction by 60%) and option '4(fix all.eccessible leaks) described above.. i„'` ® New duct �`inst��allllations cannot utillze.tiuildin`g cavities asfplenums or:platfdn returns in lieu of ducts.;. ® Mastic and draw bands must be used±in combination with cloth backed rubber adheslve.ducttape 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 -111) form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF -1R that apply to the installation have been met. . I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. 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 buildinas. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) Air Experts Air Conditioning Responsible Person's Name: Responsible Person's Signature: Paul Van Vlymen Paul Van Vlymee' CSLB License: 725283 Date Signed: 10/4/2012 Position With Company (Title): rIsthis installation monitored by a Third Party Quality Name of TPQCP (if applicable): ntrol Program (TPQCP)? ❑ Yes ❑ No Reg: 212-A0054249A-M2100001A-0000 2008 Residential Compliance Forms Registration Date/Time: 2012/10/16 21:24:52 HERS Provider: CalCERTS, Inc. March 2010 INSTALLATION CERTIFICATE* CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 5] Site Address: Enforcement Agency: Permit Number: 79311 Tom Fazio ( System 2 ), La Quinta CA 92253 City of La Quinta 12-1147 Note: If installation of a Charge Indicator Display (CID) is utilized as an alternative to refrigerant charge verification for compliance, a MECH-24 Certificate (instead of this MECH-25 Certificate) should be used to demonstrate compliance with the refrigerant charge verification requirement. TMAH and STMS are not required for compliance, when a CID is utilized for compliance. As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional form(s) for any additional systems in the dwelling as applicable. Temperature Measurement Access Holes (TMAH) and Saturation Temperature Measurement Sensors (STMS) Procedures for installing TMAH are specified in Reference Residential Appendix RA3.2. If refrigerant charge verification is required for compliance, TMAH are also required for compliance. STMS are only required for completely. new or replacement space -conditioning systems that utilize prescriptive compliance method. TMAH - Access Holes in Supply and Return Plenums of Air Handler System Name or Identification/Tag System 1 System Location or Area Served LIVING AREA 1 ® Yes ❑ No 5/16 inch (8 mm) access hole upstream of evaporative coil in the return plenum and labeled according to Figure in Section RA3.2.2.2.2. 2 ® Yes ❑ No 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 ✓ ® Pass ✓ ❑Fail t STMS - Sensor onAhe Evaporator Coil_,. _ System Name or Identification/Tag'I a eO�` System I^ li ' - .} ,, _N 'NI J , w / r / 3 (❑ Yes _ p_No The sensor is factory installed, or field installed according to manufacturer's specifications, or isoinstalled by methods/specifications approved by the Executive'_ — Director. 4 ❑ Yes. �'' ` � Y p No , "digital - The sensor wire is terminated with a standard mini plug suitable for connection to a thermometer.'TK6 sensor mini plug is accessible to the. installing,tech'nician { and the HERS rater without changing the airflow through the condenser coii' 5 ❑ Yes ❑ No ]The sensor measures the saturation temperature of the coil within 1.3 degrees F Yes to.3, 4, and 5 is a pass. Enter N/A if STMS are not applicable. Otherwise enter Pass or Fail ✓ ® N/A ✓ ❑ Pass ✓ ❑ Fail I STMS - Sensor on the Condenser Coil System Name or Identification/Tag I System 1 The sensor is factory installed, or field installed according to manufacturer's 6 ❑ Yes ❑ No specifications, or is installed by methods/specifications approved by the Executive Director. The sensor wire is terminated with a standard mini plug suitable for connection to a 7 ❑ Yes ❑ No digital thermometer. The sensor mini plug is accessible to the installing technician and the HERS rater without changing the airflow through the condenser coil 8 ❑ Yes 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 ✓ ®N/A ✓ 13 Pass ✓ ❑Fail applicable. Otherwise enter Pass or Fail Reg: 212-A0054249A-M2500001A-0000 Registration Date/Time: 2012/10/16 21:26:58 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: 79311 Tom Fazio ( System 2 ), La Quinta CA 92253 1 City of La Quinta 1 12-1147 stanaara cnarge measurement rroceoure kror use IT outdoor air ary-ouio is auove SS -r) Procedures for determining Refrigerant Charge using the standard Change 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 Conditioninq Svstems System Name or Identification/Tag System 1 (must be re -calibrated monthly) .� •dL lam. _ _ . System Location or Area Served LIVING AREA 9%6/12 (must be re -calibrated monthly) . Outdoor Unit Serial # CSD120608033 m� _ +�{ Outdoor Unit Make MAYTAG Outdoor Unit Model CSA4BF060KB Nominal Cooling Capacity Btu/hr 60000 Date of Verification 10/4/12 cauoration or uiagnostic instruments Date of Refrigerant Gauge Calibration 9/6/12 (must be re -calibrated monthly) .� •dL lam. _ _ . 1 Date of Thermocouple: Calibration 9%6/12 (must be re -calibrated monthly) . Supply (evaporator leaving) -air e; "' ,�;� measurea Iemperatures.i-rt.i € i- �.. s I `.- � tem {', 1.+�4. � . .� •dL lam. _ _ . 1 Supply (evaporator leaving) -air e; "' ,�;� m� _ +�{ `dry-bulb temperature (T db) 7'. Return (evaporator entering) air dry-bulb, s .. -,7 ...* i ,f 0',, m.. System Name or Identification/Tag'nti,.�. Syi Supply (evaporator leaving) -air e; "' - ° S8 t=,;. S8,0, m� _ +�{ `dry-bulb temperature (T db) 7'. Return (evaporator entering) air dry-bulb, 84 temperature (Treturn, db) Return (evaporator entering) air wet -bulb 64 temperature (Treturn, wb) "e. x Evaporator saturation temperature I. 44 (Tevaporator, sat) Condensor saturation temperature 109 (Tcondensor, sat) Suction line temperature (Tsuction) 64 Liquid Line Temperature (Tliquid) 100 Condenser (entering) air dry-bulb 96 temperature (Tcondenser, db) Reg: 212-A0054249A-M2500001A-0000 Registration Date/Time: 2012/10/16 21:26:58 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: I Enforcement Agency: Permit Number: 79311 Tom Fazio ( System 2 ), La Quinta CA 92253 1 City of La Quinta 1 12-1147 Minimum Airflow Requirement Temperature Split Method Calculations for determining Minimum Airflow Requirement for Refrigerant Charge Verification. The temperature split method is specified in Reference Residential Appendix RA3.2. System Name or Identification/Tag System 1 Calculate: Actual Temperature Split = Treturn, 26.00 db - Tsupply, db Target Temperature Split from Table RA3.2-3 24 using Treturn, wb and Treturn, db Calculate difference: Actual Temperature Split - 2 Target Temperature Split = Passes if difference is between -3°F and +3°F or, upon remeasurement, if between -3°F and PASS -100°F Enter Pass or Faill 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) y System Name or Iden fication/Tagi. System .1 ,� a� r Calculated Minimum Airflo R qui ement�(CFM) Measured Airflow:us 9 RA3.3 procedau esi(CFM) .&• - Passes if measured airflow is greater than or equal to the calculated minimum airflow requirement: ' I Enter Pass or Fail 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 Identificationi-rag 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 -5°F and +5°F Enter Pass or Fail Reg: 212-A0054249A-M2500001A-0000 Registration Date/Time: 2012/10/16 21:26:58 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: 79311 Tom Fazio ( System 2 ), La Quinta CA 92253 1 City of La Quinta 1 12-1147 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 = 9.0 Tcondenser, sat - Tliquid Target Subcooling specified by manufacturer 9 Calculate difference: 0 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 = 20.0 Tsuction - Tevaporator, sat Enter allowable superheat range from manufactuF&'s specifications (or use range 20 between 4°F and 25°F if manufacturer's specification is not available) • j_• " System passes if actual superheat is within -,the allowabl uperheat range. E fPASSi ^y .' ,Yy,Enter. Pass or, Fail Reg: 212-A0054249A-M2500001A-0000 ,Registration Date/Time: 2012/10/16 21:26:58 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH=25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5) Site Address:, I Enforcement Agency: Permit Number: 79311 Tom Fazio ( System 2 ), La Quinta CA 92253 City of La Quinta T12-1147 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: 725283 Date Signed: 10/4/2012 Position With Company (Title): System meets all refrigerant charge and airflow Name of TPQCP (if applicable): Control Program (TPQCP)? 0 Yes [3 No requirements. PASS Enter Pass or Fail '1 .e 'J•' i �. 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 reaistry for multiDle orientation alternatives. and beoinnino nctnher 1- 2n1 n- fnr all lnw-rice racirlanhA hnilriinnc Company Name: (Installing Subcontractor, or General Contractor or Builder/Owner) Air Experts Air Conditioning Responsible Person's Name:. Responsible Person's Signature: Paul Van Vlymen Paul Van Vlymen CSLB License: 725283 Date Signed: 10/4/2012 Position With Company (Title): Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? 0 Yes [3 No Reg: 212-A0054249A-M2500001A-0000 Registration Date/Time: 2012/10/16 21:26:58 HERS Provider: CalCERTS, Inc: 2008 Residential Compliance Forms August 2009 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-21 Duct Leakage Test — Existing Duct System (Page 1 of 2) Site Address: 79311 Tom Fazio (System 2 ), La Quinta CA 92253 Enforcement Agency: Permit Number: (System 1) City of La Quinta 12-1147 Enter the Duct System Name or Identification/Tag: System 2 of 2 _ Enter the Duct System Location or Area Served: Living area 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 - existinq 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 l 11 ess than 10% of Fan Flow ❑ 3. Reduce leakage by 60% and conduct smoke and fix all leaks ® 4. Fix all accessible leaks using smoke and HERS rater verify Note: (One of Options,l, 2, or 3 must be attempted,before.,utilizing Option,4.),,,i Determinerbminal Fan Flow using one ofithe"following three calculation methods:" �' [ ✓ IN Cooling'system method: Size of Londenser in Tons I S !'x 400 4 2000 , CFM ✓ ❑ Heating system method: 21.7 x - Output Capacity in Thousands of Btu/hr ✓ ❑ measured 'System airflow usin RA3:3 airflow est rocedures: CFM, Option'1 used then: f • __ 1 Allowed leakage = Fan Flow 2000 x 0.15 = 300 CFM Actual Leakage-'-- 613 CFM Pass if Leakage Actual is less than Allowed 13 Pass Fail Option 2 used then:_ , j 2 Allowed leakage = Fan Flow f 2000 x 0.10 200 CFM Actual Leakage to outside =_ CFM Pass if Leakage Actual is less than Allowed Pass p Fail Option 3 used then: Initial leakage prior to start of work = CFM Final leakage after sealing all accessible leaks using smoke test = _ CFM 3 Initial leakage _ - Final leakage _ = Leakage reduction CFM ((Leakage reduction _ / Initial leakage x 100% _ % Reduction Pass if % Reduction >= 600/a 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 IM Pass a Fail D, Reg: 212-A0054249A-M2100001A-M21A Registration Date/Time: 2012/10/17 14:29:17 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-21 Duct Leakage Test — Existing Duct System (Page 2 of 2) Site Address: 79311 Tom Fazio ( System 2 ), La Quinta CA 92253 Enforcement Agency: Permit Number: (System 1) City of La Quinta 12-1147 ® 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. F --x ' 7 ® All supply/an'd return register boots must be sealed to the drywall if smoke �te'st'is utilized for, compliance - applies'to duct leakage compliance option 3 (leakage reducti6n.by 60%) and option.`4�(fix all accessible leaks) described above. �� •'i('' -'!-; ®New duct�installas o ytlons cannot utilize building cavities asplenumr"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. , 1 DECLARATION STATEMENT; • I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. • I am the certified HERS rater who performed the verification services identified and reported on this certificate (responsible rater). • The installed feature, material, component, or manufactured device requiring HERS verification that is identified on this certificate (the installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified on the Certificate(s) of Compliance (CF -111) approved by the local enforcement agency. • The information reported on applicable sections of the Installation Certificate(s) (CF -611), signed and submitted by the person(s) responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -111) approved by the enforcement agency. Builder or Installer information as shown on the Installation Certificate (CF -6111) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) AIR EXPERTS AIR CONDITIONING -HEATING Responsible Person's Name: CSLB License: Paul Van Vlymen 1725283 HERS Provider Data Registry Information Sample Group # (if applicable): N/A ® tested/verified dwelling ❑ not-tested/verified dwelling in la HERS sample group HERS Rater Information CalCERTS Certificate # CCI -1798695602 HERS Rater Company Name: Air Solutions of the Desert Responsible Rater's Name: Responsible Rater's Signature: Walter W Nellis Walter W Nellis Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 10/4/2012 CC2004361 Reg: 212-AO054249A-M2100001A-M21A Registration Date/Time: 2012/10/17 14:29:17 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 r CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 5) Site Address: Enforcement Agency: Permit Number: 79311 Tom Fazio ( System 2 ), La Quinta CA 92253 1 City of La Quinta 12-1147 Note: If installation of a Charge Indicator Display (CID) is utilized as an alternative to refrigerant charge verification for compliance, a MECH-24 Certificate (instead of this MECH-25 Certificate) should be used to demonstrate compliance with the refrigerant charge verification requirement. TMAH and STMS are not required for compliance, when a CID is utilized for compliance. As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional form(s) for any additional systems in the dwelling as applicable. Temperature Measurement Access Holes (TMAH) and Saturation Temperature Measurement Sensors (STMS) Procedures for installing TMAH are specified in Reference Residential Appendix RA3.2. If refrigerant charge verification is required for compliance, TMAH are also required for compliance. STMS are only required for completely new or replacement space -conditioning systems that utilize prescriptive compliance method. TMAH - Access Holes in Supply and Return Plenums of Air Handler System Name or Identification/Tag System 2 of 2 System Location or Area Served Living area 1 ®Yes [3No 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 toYes ❑ 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 ✓ ® Pass ✓ ❑ Fail STMS - Sensor on,the Evaporator Coil._ System Narne`or Identification/Tag-3 /0/ System 2 of 2 3 ❑ Yes❑ ___r7 No � t J The sensor is factory installed, or field installed according to manufacturer's specifications, or is installed by methods/specifications approved by,the Executive Director. f 4' `•` �'r'�•,�1 .+! ❑ Yes p Yes. ' p No The sensor wire is terminated.with a standard mini plug suitable for connectionto a?,4 digital thermometer. The'sensor. mini plug is accessible to the;installing,technic & k Director. and the HERS rater without changing the airflow through the condenser coil 5 ❑ Yes.- - - •• .� ❑ No 4 When attached to a digital thermometer, the sensor provides an indication of the saturation temperature of the coil. Yes to 3, 4, and 5 is a pass. Enter N/A if STMS are not applicable. Otherwise enter Pass or Fail ✓ ®N/A ✓ ❑Pass ✓ ❑Fail STMS - Sensor on the Condenser Coil System Name or Identification/Tag System 2 of 2 The sensor is factory installed, or field installed according to manufacturer's 6 ❑ Yes ❑ No specifications, or is installed by methods/specifications approved by the Executive Director. The sensor wire is terminated with a standard mini plug suitable for connection to a 7 ❑ Yes ❑ No digital thermometer. The sensor mini plug is accessible to the installing technician and the HERS rater without changing the airflow through the condenser coil 8E3Yes [3No When attached to a digital thermometer, the sensor provides an indication of the saturation temperature of the coil. Yes to 6, 7, and 8 is a pass. Enter N/A if STMS are not ✓ ® N/A ✓ ❑ Pass ✓ ❑ Fail applicable. Otherwise enter Pass or Fail Reg: 212-A0054249A-M2500001A-M25A Registration Date/Time: 2012/10/17 14:35:27 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING, CF-411-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 2.of 5) Site Address: Enforcement Agency: Permit Number: 79311 Tom Fazio ( System 2 ), La Quinta CA 92253 City of La Quinta 12-1147 Standard Charge Measurement Procedure (for use if outdoor air dry-bulb is above 55°F) Procedures for determining Refrigerant Charge using the Standard Charge Measurement Procedure are available in Reference Residential , Appendix RA3.2. As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional form(s) for any additional systems in the dwelling as applicable. • The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure. • The system must meet minimum airflow requirements as prerequisite for a valid refrigerant charge test. • If outdoor air dry-bulb is 55°F or below, the installer must use the Alternate Charge Measurement Procedure. Space Conditioning Systems System Name or Identification/Tag System 2 of 2 (must be re -calibrated monthly) System Location or Area Served Living area ' 9/6%12=+ 1 f- — V t (must be re* -calibrated monthly) Outdoor Unit Serial # Csd120608033 ' Outdoor Unit Make Maytag Outdoor Unit Model CSA4BF060KB Nominal Cooling Capacity Btu/hr 60000 Date of Verification 10/4/12 w-anoravon or uiagnosvc instruments Date of Refrigerant Gauge Calibration 9/6/12 (must be re -calibrated monthly) is �4t. ,. Date of T`hiermocouple,Calibration 9/6%12=+ 1 f- — V t (must be re* -calibrated monthly) Supply (eva orator leavin air.d bulb r �.,�-` measures i emperaiures,v:"ry ■.r' ; , If 30Z! I 1 ` t• / k y. , apb System Name or Identification/Ta 5, stem 2 of 2 Supply (eva orator leavin air.d bulb r �.,�-` temperature (Tsupply, db) Return (evaporator, entering) air dry-bulb. 84 temperature'(Treturn, db) Return (evaporator entering) air wet -bulb 64 ' temperature (T return, wb) i Evaporator saturation temperature " 44 (Tevaporator, sat) Condensor saturation temperature 109 (Tcondensor, sat) Suction line temperature (Tsuction) 64 Liquid Line Temperature (Tliquid) 100 Condenser (entering) air dry-bulb 96 temperature (Tcondenser, db) Reg: 212-A0054249A-M2500001A-M25A Registration Date/Time: 2012/10/17 14:35:27 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-411-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5) MI Site Address: Enforcement Agency: Permit Number: 79311 Tom Fazio ( System 2 ), La Quinta CA 92253 City of La Quinta 12-1147 . 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 2 of 2 Calculate: Actual Temperature Split = Treturn, 26.00 db - Tsupply, db Target Temperature Split from Table RA3.2-3 24 using Treturn, wb and Treturn, db Calculate difference: Actual Temperature Split - 2 Target Temperature Split = , Passes if difference is between -4°F and +4°F or, upon remeasurement, if between -4°F and PASS -100OF 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 (dm/ton) System Name or Identification/Tag� b l k Calculated Minimum Airfloww Requi ement (CFM) ' - `r.e"3i�.�Ci f Wil. J• r d J?. I "' ' � . ,%a....;:. -r -�-"y Measured* Mow ,using RA3.3 procedures (CFM)l w. ? a r- Passes if measured airflow is greater than or equal to the calculated minimum airflow requirement. r I Enter Pass or Fail. Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for fixed orifice metering device systems System Name or Identification/Tag Calculate:. Actual Superheat = Tsuction - Tevaporator, sat Target Superheat from Table RA3.2-2 using Treturn, wb and Tcondenser, db Calculate difference: Actual Superheat - Target Superheat = System passes if difference is between -6°F and +6°F Enter Pass or Fail Reg: 212-A0054249A-M2500001A-M25A Registration Date/Time: 2012/10/17 14:35:27 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5) Site Address: Enforcement Agency: Permit Number: 79311 Tom Fazio ( System 2 ), La Quinta CA 92253 City of La Quinta 12-1147 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 2 of 2 Calculate: Actual Subcooling = 9.0 Tcondenser, sat - Tliquid Target Subcooling specified by manufacturer 9 Calculate difference: 0 Actual Subcooling - Target Subcooling = System passes if difference is between -4°F and +4°F PASS t� .� 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 2 of 2 Calculate: Actual Superheat = ) 20.0 Tsuction - Tevaporator, sat Enter allowable superheat range from manufacturer's specifications (or use range 20 between 3°F and 26°F if manufacturer's s specification is not „available) System passes1f actual superheat is within -the allowable superheat range PASS t� .� "' ,r!r;Ehter Pass or. Fail Reg: 212-A0054249A-M2500001A-M25A Registration Date/Time: 2012/10/17 14:35:27 HERS Provider: Ca10ERTS; Inc. 2008 Residential Compliance Forms March 2010 } INSTALLATION CERTIFICATE CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 53 Site Address: I Enforcement Agency: Permit Number: 79311 Tom Fazio ( System 2 ), La Quinta CA 92253 1 City of La Quinta 1.12-1147 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 2 of 2 172S283 HERS Provider Data Registry Information Sample Group # (if applicable): N/A System meets all refrigerant charge and airflow ❑ not-tested/verified dwelling in la HERS sample group requirements. PASS Air Solutions of the Desert Responsible Rater's Name: Responsible Rater's Signature: Enter Pass or Fail Walter W Nellis Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 10/4/2012 CC2004361 x DECLARATION STATEMENT;, . I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. • I am the certified HERS rater who performed the verification services identified and reported on this certificate (responsible rater). • The installed feature, material, component, or manufactured device requiring HERS verification that is identified on this certificate (the installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified on the Certificate(s) of Compliance (CF -111) approved by the local enforcement agency. . The information reported on applicable sections of the Installation Certificate(s) (CF -6R), signed and submitted by the person(s) responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -111) approved by the enforcement agency. Builder or Installer information as shown on the Installation Certificate (CF -6R) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) AIR EXPERTS AIR CONDITIONING -HEATING Responsible Person's Name: CSLB License: Paul Van Vlymen 172S283 HERS Provider Data Registry Information Sample Group # (if applicable): N/A ® tested/verified dwelling ❑ not-tested/verified dwelling in la HERS sample group HERS Rater Information CalCERTS Certificate # CC1-1798695602 HERS Rater Company Name: Air Solutions of the Desert Responsible Rater's Name: Responsible Rater's Signature: Walter W Nellis Walter W Nellis Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 10/4/2012 CC2004361 Reg: 212-A0054249A-M2500001A-M25A Registration Date/Time: 2012/10/17 14:35:27 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010