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12-0594 (MECH)P VNW P.O. BOX 1504. tl1q�IP� 1 �O Ail 78-495 CALLE TAMPICO ('~� + LA QUINTA, CALIFORNIA 922,5392 b t BUILDING:& SAFETY DEPARTMENT' • III �I ` " �p% Q BUILDING PERMIT Application Number:- 12-0'�0594� Owner: Property Address: 81685T3BURON DR ADAME AARON D APN: 7677532-005- - - 81685 TIBURON DRIVE Application description: MECHANICAL LA QUINTA, CA 92253 Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 110.00 Contractor: VOICE (760) 777-7012 FAX (760) 777-7011 >, INSPECTIONS (760) 777-7153. Date: 5/29/12 Applicant: Architect or Engineer: GENERAL AIR CONDITIONING 31170 RESERVE DRIVE ' THOUSAND PALMS, CA 92276 r (760)343-7488 /1^ LiC. No.. 686310 ! LICENSED C TRACTOR'S- DECLARATION WORKER'S COMPENSATION DECLARATION . I I hereby affirm under penalty of perjury that I am licen under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations: Section 7000) of Division 3 of the Business and Profe nal? Code, and my License is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided License Class: C20 - - •Lic se No.: -686310 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is ate el C tractor: - - issued. _?4 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 • -BUILDER DECLARATION insurance carrier and policy number are: I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier ZENITH INS CO Policy Number Z071741501 - following. reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to - _ I certify that, in the performance ofthe work for ich this permit is issued, I shall not employ any construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to become subje t the workers' compensation laws of California, permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I should become subject to workers' compensation provisions of Section License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of the Labor Code, I shall forthwith c ly with those provisions. 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)•: AXate:46_�Ppllcant: (_) 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: They WARNING: FAILURE TOSECUREWORKERS' C PENS TION COVERAGE IS UNLAWFUL, AND SHALL Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND -CIVIL FINES UP TO ONE HUNDRED THOUSAND and who`does the work himself or herself through his or her own employees, provided that the DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN - improvements arenot intended or offered for sale. If, however, the building or improvement is sold within • - SECTION 3706 OF�THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. , one year of completion, the owner -builder will have the burden of. proving that he or she did not build or ' ' improve for the purpose of sale.). 1,APPLICANT ACKNOWLEDGEMENT (_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application. property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed 1. Each person upon whose behalf this application is made, each person at whose request and for pursuant to the Contractors' State License Law.)._ whose benefit work is performed under or pursuant to any permit issued as a result of this application, (_) I am exempt under Sec. . , B.&P.C. for this reason the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City , - of La Quinta, its officers, agents and employees for any act or omission related to the work being • performed under or following issuance of this permit. Date: Owner: 2. Any permit issued as a result of this application becomes null and void if work is not commenced 'essation of work for 180 days will subject within 180 days from date of issuance of suckiformation CONSTRUCTION LENDING AGENCY permit to cancellation. I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the -I certify that I have read this application and state that the ais correct. I agree to comply with all work for which this permit is issued (Sec. 3097, Civ. C.)• city and county ordinances and state laws relating to buildinn, and hereby authorize representatives Name:Date: f t 's county to enter upon the above-mentioned property purposes.Lender's ,nature (Applicant or Agent): Lender's Address: LQPERMIT I . Application Number . . . . . 12-00000594 Permit . . . MECHANICAL Additional desc . Permit 40.50 Plan Check Fee 10.13 _Fee Issue Date Valuation . . . 0 Expiration Date . 11/25/12 Qty Unit Charge Per Extension ' BASE FEE 15.00 1.00 9.0000 EA. MECH FURNACE <=100K 9.00, 1.00 16.5000 EA MECH B/C >3-15HP/>100K-.500KBTU 16.50 ----------------------------------------------------------------------------- Special Notes and Comments HVAC CHANGE -OUT: INSTALL NEW 4 TON SPLIT SYSTEM OUTDOORS AT GROUND LEVEL..2010 CODES. Other Fees BLDG STDS ADMIN (SB1473) 1.00 Fee summaryCharged -------- Paid,*..Credited Due ----------------- Permit Fee Total 40.50. -.00 .00 40•.50 Plan Check Total 10.13 .00 .00 10.13 Other Fee Total 1:00 .00 .00 1.00 Grand Total 51.63 00 .00 51.63. LQPERMIT Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-IR-ALT-HVAC Climate Zones 10 - 15 Site Address: Enforcement Agency: Date: Permit #: 81685 TIBURON La Quinta, CA 92253 City of La Quinta May 26, 2012 Duct insulation Conditioned Floor - Equipment Typel List Minimum Efficiency2 - requirement Area Thermostat ❑ Package Unit ® Furnace ® AFUE 7s% ❑ COP❑ R 6 PCZ 10-13) Served by stem ® Setback ® Indoor Coil ® SEER 13.0 E3ys HSPF ❑ R 8 (CZ 14-I5) 1622 sf If not already present must be ® Condensing Unit ❑ EER ❑ Resistance installed) ❑ Other 1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF-IR-ALT-HVAC for each system. 2. Minimum Equipment Efficiencies: 13 SEER, 78% AFUE, 7.7HSPF for typical residential systems. HERS VERIFICATION SUMMARY Listed below are FOUR HVAC alteration Options. The installer decides what work is being done and picks one of the appropriate Options. Each Option lists the HERS measures that must be conducted. A copy of the forms shall be left on site for final inspection and a copy given to the homeowner. At final, the inspector verifies that the work listed on this form was in fact the work completed by.the installer. The inspector also verifies that each appropriate CF-6R and registered CF-4R forms (no hand filled CF-4Rs allowed) are filled out and signed.Beginning October 1, 2010,'a registered copy of the CF-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 F . Indoor Coil and /or CF-6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS . Furnace CF-4R forms: MECH-21 and (for split systems) MECH-25 For Split Systems: Duct leakage!}< 15.percent; RC, CCA <_ 300 CFM/ton (Minimum Air Flow Requirement), TMAH Exempted from duct leakage testing if:" ,❑ 1-Duct system was documented to have been previously sealed and confirmed through HERS verification, or ` [32. Duct systems with less than 40 linear feet in unconditioned space, or ❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos 1 04. Thefsystem*will not be Ducted (ie.;Ductless-,Mini-Split_System)-(AlsoYExemptfrom7_Refrigerant.Charge) ❑ 2. New`HVAC System Required Fbrmsa . Cut infor Changeout with" * ' ^` }j.�� CF 6R forms:'MECH-04, MECH-20 HERS, and'(for split systems) MECH-22-HERS,�- new ducts'(all new ducting all new ' MECH 25#HERS , •: t k t CF"4R';forms:.MECH 20, MECW22, MECH-25 r �� equipment), • and (for split systems) and r �. '' a' For Split System>s:,DuctKleakage�<16"percent, RC, CCA 350 CFM/ton;,FWD, TMAH, STMS, and eithefrHSPP o� PSPP. -. For Packaged Units: Duct leakage < 6 percent= 113. New-Ducts with/or without Required Forms: .. Replacement; •- F . Includes replacing or installing all new ducting and/or outdoor condensing unit CF-611 forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS and/or indoor coil and/or furnace. No or some CF-411 forms: MECH-20 and (for split systems) MECH-25 equipment changed. For Split Systems: Duct leakage < 6 percent; RC, CCA >_ 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 a 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: Danielle Garcia Signature: Danielle Garcia Company: HARRISON ENTERPRISES INC Date: May 26, 2012 Address: 31-170 RESERVE DRIVE STE A _ License: 686310 City/State/Zip: THOUSAND PALMS / CA / 92276 Phone: (760) 343-7488 it Reg:1212-A0027043A-00000000-0000 Registration Date/Time: 2012/05/26 17:56:05 HERS Provider:•Ca10ERTS, Inc. 2008 Residential Compliance Forms July 2010 Bln. # Cts}/ O Quihta Bultding at Safety Division P.O. Box 1504,78-495 Calle Tampico La.Quinta, CA 92253 -:(760) 777-7012 Building Permit Application -and Tracking Sheet Permit # liJ Project Address: I S T (Y7 r Owner's Name:. A A A CIA Me A. P. Number. Address: - S� P Legal Description: Contractor. UOMI AW GoV di 'Qn. - Plane picked up City, ST, Zip: L Telephone: tb 2 • Project Description: 225 3 Address: 13I ��(JY qlp li City, ST, Zip.-Noj�Md Pn%, Flood plain plan Telephone "ityc Plans resubmitted t 1 V Mecharikal State Lia #: # G'ading plan Arch., Engr., Designer. E'! Review, ready for correctionsrissue Electrical Address: Subcoutactor List City., ST, Zip: Called Contact Person Plumbing Telephone: Construction Type:. Occupancy: Project type (circle one): New Add'n Alter Repair Demo Sq. Ft: 2 # Stories: # Units: State Lic. #: Name of Contact Person: A ft0 �' Telephone # of Contact Person `�Q� q Estimated Value of project: ` 1000. • Q APPLICANT: DO NOT WRITE BELOW THIS UNE # Submittal Req'd Recd TRACMG PERMIT FEES Plan Sets Plan Cheek submitted Item Amount Structural Cates. Reviewed, ready for corrections Plan Check Deonsit Truss Cates. Called Contact Person Plan Check Balance Title 24 Cates. Plane picked up Construction Flood plain plan Plans resubmitted Mecharikal G'ading plan E'! Review, ready for correctionsrissue Electrical Subcoutactor List Called Contact Person Plumbing Grant Deed Plans picked up S M.L H.O.A. Approval Plans resubmitted Grading IN ROUSE:- ''` 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 h, HVAC Field Data Sheet Pg 1 of 2 Client Name /4 CJ <A rc-) --e ' Job # 13 3 W-02 Date �l Z qI � Address q?, l CQ AF S�-- TL �z uvro-r1 . L Fkq c-kNh-4q Ph # Ca cY3 1 Technicians) t )G SgPC-\ ,� P --n- Permit # Gauge/Thermocouple Calibration Date Split I Package I Some Ducts Only I All Ducts Unit' (OmIe bpe ofd) AW -W-04 , i mentDatrz System Location or Area Served ZONE I ZOW ZOAW 3 ZONE4 Heating Equipment Make Heating Equipment Model (.,r e. r-� 0 'SL- 80u Mq "(a.Q e- AReference Number RI �3� 8� t Z Heating EquipmentAFUE �- Duct Location (attic, crawlspace, etc.) q-��c Duct R -Value (if ducts were installed) All -- Heating Load Heating Equipment Output Capacity Condenser Make "7. 52'9 n n, c - _ Condenser Model -x-I.0 - 3 ' 0 Size in Tons SEER & EER Zi T'0 h.l 00 Cooling Load y g Cooling Capacity C4 11M 'C.fl-2D&,�1 DuctTwdng Duct leakage pretest result Dnct Leakage Irma[ Result 4a 4CFM/toa to pass (646) PmIFA POWIPA Passifto Duct Leakage Final Result e60 CFM/tones pass (15%) Pass using 60% leakage reduction? 12ZO FIFA FmIFafl pawpw Pass using smoke and visual inspection? MECN22or: A CNZ5 'Coolir{gcOHAI flow& Pan. atE or+ w . Measured Air Volume from Flow Grid or Hood NEW DUCTS Target 350 CFM/tm x Condenser Tons CHMGEOUT Target: 300 CPM/ton x condenser Tons Measured air greater than Target? (YIN) Measured San Watt Draw Target 058 watts/measured CFM = Measured Watts less than Target? (Y/N) CoffrW 0 MI EDS EnerV Drtm Solatrons, hm HVAC Field Data Sheet pg 2 of 2 Client Name A..Cr CA CYN:C Job # ILLS,C--�ate Z -Il I Z **ALL APPMCABLEBOW ON TXISFORMMUST BECOMPLETED FOR EAGRIOR NO EMPTIONI •' Copyd& 0 2011 MDS &OU Dave Solutions. Inc MECIY ZS Charge & A& row - ZONE 1 ZONE2 ZONE -9 ZONE 4 Condenser Serial Number $-.,g j 7cio2w Supply air dry bulb temperature S Return air dry bulb temperature Ca Return air wetbulb temperature 6 Evaporator Saturation Temperature Sid Condenser Saturation Temperature /d o Suction Line Temperature �3 Liquid Line Temperature Suction Pressure lZ Liquid Pressure 3Z Actual Airflow Temperature Split Z Target Temperature Split from Table RA3.2.3 2. Passes if difference is t 3° of Target Temp (Y/N) Actual Subcooling (t 4° of Target to pass) Target Subcooling from Mfr. Actual Superheat (3 to 26° to pass) / Outside air dry bulb temperature � MECEi 26 "we h-ln Chmgfng below 55° . Actual Line Set length (ft) a� Mfrs Standard Line Set Length (ft) Length Difference = Correction Factor (ounces per foot) Target: Correction Factor x Length Difference System Charged to Target? (Y/N) Other Data Minimum amps 'r Maximum amps `%�' Breaker size Y Compressor amps Return Static Pressure Supply Static Pressure Supply Air Wet Bulb Temperature ---------- **ALL APPMCABLEBOW ON TXISFORMMUST BECOMPLETED FOR EAGRIOR NO EMPTIONI •' Copyd& 0 2011 MDS &OU Dave Solutions. Inc CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-21 Duct Leakage Test — Existing Duct System (Page 1 of 2) Site Address:Enforcement Agency: Permit Number: 81685 TIBURON, La Quinta CA 92253 (System 1) City.of La Quinta . 12-594 Enter the Duct System Name or Identification/Tag: System 1 Enter the Duct System Location or Area Served: Whole House Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the dwelling. This installation certificate is required for compliance for alterations and additions in existing dwellings to space conditioning systems and,duct systems. Note: For existing dwellings, a completely new or replacement duct system can also include existing parts of the original duct system (e.g., register boots, air handler, coil, plenums, etc.) if those parts are accessible. and they can be sealed. For a completely new or replacement duct system installed in, an existing dwelling, use the Installation Certificate titled "Duct Leakage Test - Completely New or Replacement Duct.System:" Duct Leakage Diagnostic Test - existing dud system Select one compliance method from the following four choices. 1. Measured leakage less than 15%'of.fan flow ' ❑ 2. Measured leakage to outside,less,than 10% of Fan Flow ' 3. Reduce leakage by 60% and conduct smoke and fix all leaks L 4!'.Fix all accessible, leaks using smoke and HERS rater verify Note'.(One of Options 1; 2, or 3 must be attempted before utilizing Option 4.) Determine nominal=Fan Flow using one of the,following,threeucalculation methods ®Cooling system'method: Size of condenser m.Tons_ 1600 CFM. O Heating 21-7 Output Capacity Btu/hr system method: x = in'�Thousands of _ CFM ✓ ❑ Measured systemrairflo a us "ng RA3 3 airFlow testkprocedures:. - .CFM . ,,• r ^ - - r s 1 Allowed leakage" Fan Flower 1600 x 0 15 =, 240 CFM' 10ptionA,,used;then`�; Actual Leakage = ' 233 CFM: ; , s r "i_. a (Pass if Leakage Actual is less than Allowed Ei Pass a Fail Option 2 used.then:- 2 . Allowed leakage'= Fan Flow 'y x 0.10 = _ CFM' ' Actual Leakage to outside = i_=CFM Pass if Leakage Actual is less than Allowed Pass Fail Option 3 used then: Initial leakage prior to start of work = _ CFM , Final leakage after sealing all accessible leaks using smoke test= _ CFM 3 Initial leakage _ - Final leakage _ = Leakage reduction CFM ((Leakage reduction _ / Initial leakage ) x 100% _ % Reduction - Pass if % Reduction > 60% Pass Fail'. Option 4.used then: 4 All accessible leaks repaired using smoke: HERS rater must verify (No sampling). No smoke allowed to leak from system. Including ducts, plenums, air handler and door panel. Pass if all accessible leaks have been repaired using smoke Pass Fail Reg: 212-A0027043A-M2100001A-M21A Registration Date/Time: 2012/06/12 22:03:24 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms , _ March 2010 • . u CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4111-MECH-21 Duct Leakage Test — Existing Duct System (Page 2 of 2) Site Address: Enforcement Agency: Permit Number: 81685 TIBURON, La Quinta CA 92253: (System 1) City of La Quinta 12-594 ' , . 0 Outside air (OA) ducts,for Central: Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off during duct leakage testing. CFj'OA ducts that utilize controlled motorized dampers, that open only when OA , ventilation:is.required: to meet ASHRAE Standard_ 62.2, and close when OA ventilation is not required; may be configured to the closed position during duct leakage testing. 0 All supply andxreturn register bootsmust bepsealed�toxthe drywall-if+smok6Aestiis,..utilized�for:'compliance - applies to duct leakage compllanceroptlon 3 (leakage reduction byi,60%)' andioption�4'rfix all accessible leaks) described above `,' _ Y 0 New duct installations cannot ut Ilze building cavities a plenums or platform returns in;Ileu of�ducts" = +- 0 Mastic and draw bands. must be used'in "Al corn bin atlon'wlth'cloth backed,rubbe- adhesfve. duct tapettoseal r leaks,at allenew duct'.connectionsy: aFk-� 4 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 rpk domed 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 r on the Certificate(s) of Compliance (CF -1R) approved by the local enforcement agency. t . 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 -IR) approved by the enforcement agency. - < 1 - Builder or Installer information as shown on the Installation Certificate (CF -6R) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) HARRISON ENTERPRISES INC Responsible Person's Name: CSLB License: Danielle Garcia 1686310 HERS Provider Data Registry Information Sample Group # (if applicable): 318661' Q tested/verified dwelling ❑ not-tested/verified dwelling in la HERS sample group HERS Rater Information CaICERTS Certificate # CC1-1798659243 HERS Rater Company Name: - The Energuy CA LLC t Responsible Rater's Name: Responsible Rater's Signature: William David Painter William David Pointe Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 6/12/2012 CC20OS784 Reg: 212-A0027043A-M2100001A-M21A Registration Date/Time: 2012/06/12 22:03:24 HERS Provider: CalCERTB„ Inc. 2008 Residential Compliance Forms March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 5) Site Address: r Enforcement Agency: Permit Number: 81685 TIBURON, La Quinta CA 92253 City of La Quinta 12-594 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. t , TMAH - Access Holes in Supply and Return Plenums of Air Handler f System Name or Identification/Tag System,i - ' System Location or Area Served Whole House I .. • - - 1 B Yes ' ❑ No ;r 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 B 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 land 2 -is a pass.:. E. Enter Pass or Faill ✓ B 'Pass ✓ ❑Fail STMS %. Sensor„ongthen Evaporator. Coil System, NameJor,Identification/Tag "'r�!°" rSystem.lz a �x , ' .�`a• - 3 ❑ Ye p No The sensor is facto ' installed-onfield installed'acdordin to manufacturer.'s specifications, or is installed by methoAifspecifications pproved by the Execut ve ❑ Yes ❑ No o of t Director 4 ,f sf 5 The�sepsorr wire s terminated with a standard..mmi•plug,suitable for connedionJto a dig�talthermometer Yes ; ❑:No The sensor mini plug is'a¢cessible to the install ingitechnician ❑ Yes ❑ No digital thermometer. The sensor mini plug is accessible to the installing technician _ r �.. and.the;HERSfrater without,'changing the airflow thlr'ough the`condens'er coil 5 ❑ Yes. --, ❑ No When attached to a digital thermometer, the sensor provides an indication of the Yes .,—.- r 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 , ✓ B N/A ✓ ❑ Pass ✓ ❑ Fail STMS - Sensor on the Condenser Coil System Name or Identification/Tag � System 1 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 80 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 ✓ B N/A ` ' ✓ [3 Pass ✓ ❑ Fail applicable. Otherwise enter Pass or Fail Reg:"212-A0027043A-M2500001A-M25A ,-Registration Date/Time: 2012/06/12 22:02:36 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 It r 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 r , System Name or Identification/Tag System 1 Calibration -of Diagnostic Instruments Date of Refrigerant Gauge Calibration - ; F _ • • System Location or Area Served Whole House ""n;t.A +.i y f".r + 6/i/2O12 ` iF Outdoor Unit Serial # 5812c10266 Outdoor Unit Make lennox l Outdoor Unit Model xc21O4823017 ` Nominal Cooling Capacity Btu/hr =: 48000 Date of Verification '.E 6/12/2012 ; , System Name or Identification/Tag System 1 Calibration -of Diagnostic Instruments Date of Refrigerant Gauge Calibration - 6/1/2012 (must be re -calibrated monthly) _ • :...-ra-1 �y .%� G.! ,,�;,� °watt'" �3 1`a•e� •°-"-- F ,'S".et-. -'• t-2�x' Date of The mocoupleiCalibraton ""n;t.A +.i y f".r + 6/i/2O12 .4—1 .'!�5:e',I't T 7�. ,.,„(must be re -calibrated. monthly) iF Supply'(evaporatorleaving) ,air dry-bulb'�,%,R 54 Measured Temperaturesx,s` ,.fir +` a.41d4: ', h ®pk a System Name or Identification/Tag., g Ms System 1, w Y �'.r::,' �y .%� G.! ,,�;,� °watt'" �3 1`a•e� •°-"-- +�'�� { {:. ��, !'-'� Supply'(evaporatorleaving) ,air dry-bulb'�,%,R 54 temperature (.Tsupply•db) Return. (evaporatorentering) air dry-bulb 75 ` temperature (Treturn . Return (evaporator entering) air wet-rbulb 63 temperature (Treturn wb) `� I', Evaporator saturation temperatur.;e 45 (Tevaporator,'sat) Condensor saturation temperature 102 (Tcondensor, sat) Suction line temperature (Tsuction) 60 Liquid Line Temperature (Tliquid) 94 Condenser (entering) air dry-bulb 92 temperature (Tcondenser, db) • Reg: 212=A0027043A-M2500001A-M25A Registration Date/Time: 2012/06/12,22:02:36 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms _ � March 2010- Minimum Airflow Requirement ed, Superheat Charge Method+Calculations for Refrigerant Charge Verification. This procedure is required to be us Temperature,Split Method Calculations for determining Minimum Airflow Requirement for Refrigerant Charge, Verification. The temperature split method is specified in Reference Residential Appendix RA3.2. System. Name or Identification/Tag System i ' Calculate: Actual Superheat = - i Tsuction - Tevaporator, sat Calculate: Actual Temperature Split = Treturn, 21.00 Target Superheat from Table RA3.2-2 using db - Tsu I db Treturn, wb and Tcondenser, db Target Temperature Split from Table RA3.2-3 18.6 ` using Treturn, wb and Treturn, db - , Actual Superheat - Target Superheat = Calculate difference: Actual Temperature Split - 2:4 " System passes if difference is between -6°F and Target Temperature Split = +6°F ' Passes if difference is between -4°F and +4°F or, Enter Pass or Fail upon remeasurement, if between -4°F and - PASS -100°F ' Enter Pass or Faii 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 Na e o d nbfcation/Tag 31 Calculated Minimum Airflow Requirement (CFM) wAr Measured Airflow ung RA3.3 procedures (CFM,,),4 Passes if measured airflow is greatet than or^ - equal to the calculated minimum airflow requirement" 1` ° r r,; ` Enter Pass or Fail ed, Superheat Charge Method+Calculations for Refrigerant Charge Verification. This procedure is required to be us 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 ` t •, - - + . Reg: 212-A0027043A-M2500001A-M25A1 Registration Date/Time: 2012/06/12 22:02:36 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: 81685 TIBURON, La Quinta CA 92253 City of La Quinta 1-12-594 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 i Calculate: Actual Subcooling = 8.0 Tcondenser, sat - Tliquid _ . Target Subcooling specified by manufacturer 10 Calculate difference: -2 Actual Subcooling - Target Subcooling = 4-25', System passes if difference is between - -4°F and +4°F , I 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 i Calculate: Actual Superheat= Tsuction - Tevaporator, _ . sat Enter allowable superheat range from; manufacturer's'specifications (or use range 4-25', between 3°F and 26°F if manufactur'er's specification. is not available) System, passes ffactual'.superheat is,. With i Wthe; allow range ,! � g�0�•w ;� PASS" Pass or,Fail „aEnter e s� x � a j'r'�-�� i <'.s«,{^'�.�� tea' :�...y. �..,,'� `"'.`.f`'r. . � ,»+a''�e �� ''..:,u.�.�6ac° ar "�:,- �—•r,.�; ' Reg: 212-A0027043A-M2500001A-M25A j:Registration Date/Time: 2012/06/12 22:02:36 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE 4+. • CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5) Site Address: Enforcement Agency: Permit Number: 81685 TIBURON, La Quinta CA 92253 City of La Quinta 12-594 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. ` Y System 1 INSTALLATION CERTIFICATE 4+. • CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5) Site Address: Enforcement Agency: Permit Number: 81685 TIBURON, La Quinta CA 92253 City of La Quinta 12-594 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 686310 HERS Provider Data Registry Information s Sample Group # (if applicable): 318661" System meets all refrigerant charge and'airflow not-tested/verified dwelling in sample group requirements. PASS The Energuy CA LLC Responsible Rater's Name: Responsible Rater's Signature: Enter Pass or Fail William David Painter , Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 6/12/2012 CC20OS784 ' �x �,- H DECLARATION STATEMENTS , • I certify under penalty of. perjury, undetahe laws of the State of California, the information provided on this form is true and correct. • I am the certified HERS rater who 01erformed 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 -611) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) HARRISON ENTERPRISES INC ; Responsible Person's Name: CSLB License: Danielle Garcia . 686310 HERS Provider Data Registry Information s Sample Group # (if applicable): 318661" Q tested/verified dwellingFRERS not-tested/verified dwelling in sample group HERS Rater Information CalCERTS Certificate # CCI -1798659243 HERS Rater Company Name: The Energuy CA LLC Responsible Rater's Name: Responsible Rater's Signature: William David Painter William David Painter , Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 6/12/2012 CC20OS784 ' Reg: 2127A0027043A-M2500001A-M25A Registration Date/Time: 2012/06/12 22:02:36 j HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 STALLATION CERTIFICATE CF-6R-MECH- ace Conditioning Systems, Ducts and Fans (Page 1 o1 eAddress: Enforcement Agency: Permit Number: 685 TIBURON, La Quinta CA 92253 (System 1) City of La Quinta 12-594 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 Lennox SL280UH09OXV60C 4358917 1 180 AFUE Attic 74 75 kBtu (package+.:�: ;heat * CEGCertified Mfr. Name ; ARI Reference # of Identical 1, 3 (>=CF -1R crawl- space, Duct Cooling Load Cooling Capacity pump) and Model Number;• Number2 Systems value)4 . etc.) R -value (kBtu/hr) (kBtu/hr) A/C XC2 , 048-230-06 " 1 ' ; 13 EERox 18 R, I! Attie - 48 -,;.:: 4 Tons coonn9 Equipment r+ Equip . =' erg + w'` Efficiency (SEER Duct Location r Type ?r "c "' and EER) (attic, (package+.:�: ;heat * CEGCertified Mfr. Name ; ARI Reference # of Identical 1, 3 (>=CF -1R crawl- space, Duct Cooling Load Cooling Capacity pump) and Model Number;• Number2 Systems value)4 . etc.) R -value (kBtu/hr) (kBtu/hr) A/C XC2 , 048-230-06 " 1 ' ; 13 EERox 18 R, I! Attie - 48 -,;.:: 4 Tons 4�i,%'E• F"1''J 1�. j� r f f�i 1-��. _ �SL�t +4i`' .'�+�+ ��i!•,R i �.'Jr ;.+� '',W,'3Olt .a a✓ } .�#,^, ♦ .,p„,y s'ce�' c:Y, qty ,., t .i -''r.,:."�' RFs?'. ,.: - ..r t.,t!•R7 4 -yam` r Fit 1.. 4.. 1 4 1. If:pro�ect is'new construction, see -Footnotes to Standards Table 151-8 and Table 151-C for duct ceiling alternative ' compliance. r 2. ARI Reference Number can -;be foun•d:by entering the equipment model number at http://www.aridirectory.or4%a i%ac:ph #. .3. Listed efficiency on this page:mustbe greater than or equal ( ? ) to the value shown on the CF -1R 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 0 §110-§113:'HVAC equipment is certified by the California Energy Commission. 0 §150(h): Heating and/or cooling loads calculated in accordance with ASHRAE, SMACNA, or ACCA. 2 §150(1): Setback Thermostat on all applicable heating and/or cooling systems meet the requirements of §112(c). 0 §150(j)2: Pipe insulation for cooling system refrigerant suction, chilled water and brine lines meets minimum requirements of•Table 150-B and includes a vapor retardant or is'enclosed entirely in conditioned space. Reg: 212-A0027043A-M0400001A-00,00 ,,Registration Date/Time' 2012/05/30 13:01:25 HERS Provider: CalCERTS„ Inc. 2008 Residential Compliance Forms August 2009 i mi INSTALLATION CERTIFICATE CF-6R-MECH-04 Space Conditioning Systems, Ducts and Fans (Page 2 of 2) Site Address: Enforcement Agency: Permit Number: 81685 TIBURON,'La Quinta CA 92253 (System 1) City of La Quinta 12-594 Ducts and Fans ' §150(m): Duct and Fans 0 1. All air -distribution system ducts and plenums installed, sealed and insulated to meet the requirements of CMC Sections 601, 602, 603, 604, 605 and Standard 6-5; supply -air and return -air ducts and plenums are insulated to a minimum installed level of R-4.2 or enclosed entirely in conditioned space. Openings shall be sealed with mastic, tape or,other duct -closure system that meets the applicable requirements of UL 181, UL 181A, or UL 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 0 1. Building cavities, support platforms for air handlers, and plenums defined or constructed with .materials other than sealed sheet metal, duct board or flexible duct shall not be used for conveying, conditioned air. Building cavities and support platforms may contain ducts. Ducts installed'in cavities and support platforms shall not be compressed to cause reductions in the cross-sectional area of the ducts. 0 2D. Joints -and seams of duct systems and their components shall not be sealed with cloth back . rubber -adhesive duct tapes unless such tape is used in combination with mastic and draw bands. 0 7. Exhaust fan systems have back draft or automatic dampers. 0 8. Gravity ventilating systems serving conditioned space have either automatic or readily accessible, manually operated dampers::::. 0 Protection of InsulatioriMnsulation 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 thatis water retardant and provides shielding from solar radiation that can cause ..S•degradatio.n'ofihe materiali(1 ''. 0 10. Flexible ducts cannot have:porous inner cores. D . 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 Drovides to the building owner at occuoancv. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) HARRISON ENTERPRISES INC Responsible Person's Name: Responsible Person's Signature: Danielle Garcia Danielle Garcia . CSLB License: Date Signed: Position With Company (Title): 686310 5/24/2012 Reg: 212-A0027043A-M0400001A-0000 Registration Date/Time: 2012/05/30 13:01:25 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms' August 2009 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. 0 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 ..%"'tae:; r , 13 4:Fix all ;accessible leaks' using; smoke and HERS rater verify Nofe:w(One of Options 1, 2 or 3 m1be attempted before utilizing Option 4.) Determine ✓� norm.inraalA�-, a, •n Flow using on..er ohre�°.following three calcu,lat:ion methods m Coolingystem,method: Size -6f condenserm Tons,4v400•=� 1Nz :g r T1 04 ✓ 13 Heating system method422`l 7 x _Output Capacity in Thousands of Btu/hr' CFM or 4 ✓ ❑ Measured system airflow using�W 3'airflow,t est}procedures CFM ,:a:•�o a � -^ .�, �+ �1 Option ijusftthen Allowed leakage ,Fan. Airflow 1600` x 0.1-5 240 CFM • q'- Actual Leakage;=" •,230 CFM<:r� c• Pass if Actual Leakage is less than Allowed leakage Pass Fail * 2 Option 2 used then: Allowed, eakage F,an Airflow K; h_f x 0.10 = = CFM , Actual Leakage to outside =A•CFM ' F' teass if Actual leakage to outside is less than Allowed leakage ❑ Pass ❑ Fail Option 3 used then: x x: Initial leakage prior to start.of.work = CFM Final leakage after sealing all accessible leaks using smoke test = _ CFM ' 3 Initial leakage _ - Final leakage _ = Leakage reduction _ CFM ((Leakage reduction_/ Initial leakage_) x 100%= % Reduction , Pass if % Reduction > 60% Pass Fail Option 4 used then: 4 All accessible leaks repaired using smoke test. HERS rater must verify (No Sampling). • Pass if all accessible leaks have been repaired using smoke p Pass ❑ Fail'• Reg: 212-A0027043A-M2100001A-0000 'Registration Date/Time: 2012/05/30 13:02:•36* HERS Provider: CalCERTS, Inc. •2008 Residential Compliance Forms March 2010 r y • ail:;.:, � - 0 Outside air (OA) ducts" for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off " during duct leakage testing: CFI-,QA'ducts that utilize controlled motorized dampers, that open only when OA - ventiIla' tion;is_required to meetAS'HRAE Standard 62.2, and close when OA ventilation is not required, may be configured to"the closed position during duct leakage testing. z o AII'supply andtrieturn register boots must-sbe.,seale&to the. dry-wallif smoke test is utilizedxfor-compliance — applies.to�duct;leakage compliance option 3 (leakage reduction by,60%)ranaToption 4 (fix all accessible 00 leaks described abovef ff �( n ,�* F•.•x , rr xy(,*+�"•x r5y,..�.iL F�._5 ,,.,fit-.+u''ry*^�a. New ducttinstallations,.canno4/UUlize building cavities as plenums or platform .returns iri-I urof,ducts. v r ` 11 -� Mastic and`drawibands must be used�inlcom, ination withlcloth backed rubber*adhesive ductatape"toseal leaksatallfnew,duct connections' '� , ,r; - . �, r r ,}' h�~°•° DECLARATION STATEMENT • I certify under penalty. of..p Yjury, uncle th`e laws of the State of California, the information provided on this form is true and correct: • I am eligible under.Divisfon'3:9ro 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 aril 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. 4 • I reviewed a copy of the Certificate of Compliance (CF -SR) form approved by the enforcement agency that identifies the specific F requirements for the installation. I certify that the requirements detailed on the CF -1R that apply to the installation have been met:' • I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the ` building permit(s) issued for the building, and made available to the' enforcement agency for -all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder+' provides to the building owner at occupancy. I will ensure that all Installation Certificates will come from a HERS provider data )registry for multiple orientation alternatives, and beginning October 1, 2010, for all low-rise residential buildings. 'Reg: 212-A0027043A-M2100001A-0000, Registration Date/Time: 2012/05/30 13:02:36 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms, . March 2010 n Company Name: (Installing Subcontractor or General CB on or uilder/Ower) HARRISON ENTERPRISES INC - Responsible Person's Name: ' , Responsible Person's Signature: . Danielle Garcia Danielle Garcia t CSLB License: Date Signed: Position With Company (Title): 686310 5/24/2012 F this installation monitored by a Third Party Quality Name of TPQCP (if applicable):ontrol Program (TPQCP)? []Yes ❑ No ' 'Reg: 212-A0027043A-M2100001A-0000, Registration Date/Time: 2012/05/30 13:02:36 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms, . March 2010 n Company Name: (Installing Subcontractor or General CB on or uilder/Ower) HARRISON ENTERPRISES INC - Responsible Person's Name: ' , Responsible Person's Signature: . Danielle Garcia Danielle Garcia t CSLB License: Date Signed: Position With Company (Title): 686310 5/24/2012 F this installation monitored by a Third Party Quality Name of TPQCP (if applicable):ontrol Program (TPQCP)? []Yes INSTALLATION CERTIFICATE* CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 5) Site Address: Enforcement Agency: Permit Number: 81685 TIBURON, La Quinta CA 92253 City of La Quinta 12-594 Note: If installation of a Charge Indicator Display (CID) is utilized as an alternative to refrigerant charge verification for • compliance, a MtCH-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 forryi(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 PleAums of Air. Handler 4 System Name or Identification/Tag System System Location. or -Area Served Whole House 7- 1 0 Yes [3 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 [a Yes 11NO Y Yes,.VAand 2js-.a..Pass. WO Enter Pass or Fail l V 0 Pass ✓ 0 Fail. El Yes m The Sensor wire is term i n6t&d:;With a4stan'd6rd"m''ini, plug -suitable, for conn"ectio' in4o,'id l'ItC n- ug,Tisaccessibletbiihbhnic-i -N L p ,ihieallingktec ❑ Yes [].No _Ej andthe-HEks:raterLwithoutchargin6ffie,ai rougWihL.Eondinser coil 757,11 0 Yes -:`-1�.�.-'.:[7'_ - No INSTALLATION CERTIFICATE* CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 5) Site Address: Enforcement Agency: Permit Number: 81685 TIBURON, La Quinta CA 92253 City of La Quinta 12-594 Note: If installation of a Charge Indicator Display (CID) is utilized as an alternative to refrigerant charge verification for • compliance, a MtCH-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 forryi(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 PleAums of Air. Handler 4 System Name or Identification/Tag System System Location. or -Area Served Whole House 7- 1 0 Yes [3 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 [a Yes 11NO 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,.VAand 2js-.a..Pass. WO Enter Pass or Fail l V 0 Pass ✓ 0 Fail. STMS= Sensor -on -the Evaoorator.- Syst6m%am'k,r,o1 oe'ritificationirragI.- stem I 3 _Afx es.. 0 Yes The sensor is factory installed, or field installed according to manufacturer's The sensor . is fa-ctorj"yi'nstzilli�dbr�field!iristall(�d-kcordind'�torhahufaeturer'svi�.�, specifications, or isgins'ta[14,d!by mi6th6d's/,sp6-c'itic'at'lion's approved the"Executive 0 Yes 0 No specifications, or is installed by methods/specifications approved by the Executive ire6to'r 14A VVFby 6 4 El Yes m The Sensor wire is term i n6t&d:;With a4stan'd6rd"m''ini, plug -suitable, for conn"ectio' in4o,'id l'ItC n- ug,Tisaccessibletbiihbhnic-i -N L p ,ihieallingktec ❑ Yes [].No _Ej andthe-HEks:raterLwithoutchargin6ffie,ai rougWihL.Eondinser coil 757,11 0 Yes -:`-1�.�.-'.:[7'_ - No measures thesaturation temperature of the coil withih'1.3 degrees F Yes'to.1*3,14-6h�d,5.is,a'�pass. Enter N/Xif STMS are not �7 1 Pass or*F' 'ai V [a N/A V .[] Pass V , [3 Fail NX, STMS - Sensor on the C6ridenser.'Coll System Name or Identification/Tag n,'�,...;.;" System 1 e The sensor is factory installed, or field installed according to manufacturer's 6 0 Yes 0 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 0 Yes [:3 No The sensor measures the saturation temperature of the coil within 1.3 degrees F Yes to 6, 7, and 8 is a pass. Enter N/A if STMS are 70 ' Y'. 2 N/A ✓ JP Pass Fail applicable. Otherwise enter Pass or Fail' • Reg: 212-A0027043A-M250000IA-0000. Registration Date/Time: 2012/05/30.13:07:54 r 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: 81685 TIBURON, La Quinta CA 92253 City of La Quinta -12-594 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 ' - _ Y System Name o� Identification/Tag System 1 (must be re -calibrated monthly) Date of,Thermoouple�Calibration �s 5/1/2012j° System Location or Area Served Whole House Outdoor Unit Serial .# 5812C10266 -., ., *•.�. .,..r� k- 4N a E�- Outdoor Unit Make Lennox Outdoor Unit Model XC21-048-230=06 Nominal Cooling Capacity Btu/hr•,i-';: .; •48000 Date of Verification a� - 5/24/2012 Calibratidh�of: Diagnostic Instruments zy; 9 yet, Date of Refrigerant Gauge Calibration 74 5/1/2012 (must be re -calibrated monthly) Date of,Thermoouple�Calibration �s 5/1/2012j° (must be re -calibrated month) • Measured Tem eraturesf(°F) ' .. _ f �c„j/ fv f.+ .Na a or Iden Systemtif t o mag I g11 tkit.: . �.��' �{ +rs 4,� SuPPlY (evapora�tor€I�eaving)aair dry-bulb, t► = temperature't(Tsu 'db) »� ,. ... ,yc -., ., *•.�. .,..r� k- 4N a E�- I pP Y, Return (evaporator:"entering) air dry-bulb^ temperatur(e, T- `� ) so .return;. db I � s'� Return (evapo'rator'entering) air wet bulb 63 temperature (Treturn Evaporator saturation temperafiire, S0' (Tevaporator, sat) ; �� ,.� ' Condensor saturation temperature 100 (Tcondensor, sat) Suction line temperature (Tsuction) 63 Liquid Line Temperature (Tliquid) 96 Condenser (entering) air dry-bulb 95 temperature (Tcondenser, db) Reg: 212-AO027043A-M2500001A-0000 Registration Date/Time: 2012/05/30 13:07:54 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 I Reg: 212-AO027043A-M2500001A-0000 Registration Date/Time: 2012/05/30 13:07:54 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5) Site Address:, Enforcement Agency: Permit Number: 81685 TIBURON, La •Quinta CA 92253 City of La Quinta 12-594 Minimum Airflow Requirement Temperature Split Method Calculations for determining Minimum Airflow Requirement for Refrigerant Charge Verification. The temperature split method is specified in Reference Residential Appendix RA3.2. System Name or Identification/Tag System 1 - Calculate: Actual Temperature Split = Treturn, 21.00 db - Tsupply, db Target Temperature Split from Table RA3.2-3 21 using Treturn; wb and Treturn, db • ' 'Calculate difference: Actual Temperature Split = 0 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 Fail rs 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. 4 Calculated Minimum Airflow .Requirement (CFM) = Nominal Cooling Capacity (ton) X 300 (cfm/ton) .�: - , System:Nayme or�Identification/Tag: t• y �rfe��' �i► pil�7 �� _ �f ..�}'}F � �,yY r' �§�-. �. ySystemtij7� � r wwt� ��'t t..k �. '�� ,�i+� -.5+' . Calculated Minimum Airflow��Requirement (CFM) ' f f MeasuredtAirflow,using RA3.3 procedures (CFM).! 3 C t Passes if measured":airflow is;greater than or" e3,'? °t"'-111111 . W ,, _, su equal to the calculated- minimum airflow, ; requirement. , . '�' 01 Enter=Pass or Fail Superheat Charge Method;`Calculations for Refrigerant Charge Verification. This procedure is required to be used for fixed orifice metering device',systems System Name or Identification/Tag,' - System 1 Calculate: Actual Superheat = Tsuction - Tevaporator, sat 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-A0027043A-M2500001A-0000 Registration Date/Time: 2012/05/30 13:07:54 HERS Provider: CalCERTS,.Inc. 2008 Residential Compliance Forms August 2009 • .. i - tet• i+ . INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification,- Standard Measurement Procedure (Page 4 of 5) Site Address:_ - Enforcement Agency: Permit Number: 81685 TIBURON, La Quinta CA 92253 City of La Quinta. 12-594 Subcooling Charge Method Calculations for Refrigerant Charge Verification: This procedure is required to be used for thermostatic expansion valve (T XV) and electronic expansion valve (EXV) systems. r System Name or Identification/Tag System 1'., - Calculate: Actual Subcooling Tcondenser, sat - Tliquid 13.0 Target Subcooling specified by manufacturer 4 , Calculate difference: 0 Actual Subcooling - Target Subcooling = 3-26 + System passes if difference is between Y , ASS� -3°F and +3°F • PASS' +` i ?!d ? °r '.*. a ?; w F : Enter Pass or Fail Metering Device Calculations for Refrigerant Charge Verification: This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag System i ' Calculate_ Actual Superheats ri` 13.0 suction evaporator, set u-. ibyc 9 , Enter -allowable. superheat range from---",, manufacturer s specifications (or use range between 4°F and 250F. if manufacturers;:.- specification isnot available) 3-26 System�passesrif,actual'superheat is•withimthe allowabesuper heat^`or,Fail Y , ASS� � • rt,,� _ . iE_ .. • +` i ?!d , r L °r '.*. a ?; w F : Reg: 212-A0027043A-M2500001A-0000 Registration Date -/Time: 2012/05/30 13:07:54 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms - August 2009 STALL'ATION CERTIFICATE CF-6R-MECH-25-HEI 4rigerant Charge Verification - Standard Measurement Procedure (Page 5 of to Address: Enforcement Agency: Permit Number: 1685 TIBURON, La Quinta CA 92253 City of.La Quinta 12-594 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: 686310 Date Signed: 5/24/2012, 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 j` �� ;y,�°Y�'"Q�w�n,�. `""r...� �e'^'"'� +�+�+•R`s�x ..�,'z".e,��u��"�!,r' " DECLARATION STATEMENT y • I certify under penalty of pe�q'ury, 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:khe Business and Professions Code to accept responsibility for construction, or an authorized representative of the person responsible for construction (responsible person). ,- • I certify that the installed features; -materials, components, or manufactured devices identified on this certificate (the installation) conforms to all applicable codes and -regulations, and the installation is consistent with the plans and specifications approved by the enforcement agency. • I understand that a HERS rater will check the installation to verify compliance, and that that if such checking identifies defects, I am required to take corrective action at my expense. I understand that Energy Commission and HERS provider representatives will also perform quality assurance checking of installations, including those approved as part of a sample group but not checked by a HERS rater, and if those installations fail to meet the requirements of such quality assurance checking, the required corrective action and additional checking/testing of other installations in that HERS sample group will be performed at my expense. • I reviewed a copy of the Certificate of Compliance (CF -1R) form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF -1R that apply to the installation have been met. • I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all 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 reoistry for multiple orientation alternatives. and beainnino October 1. 2010. for all low-rise residential huildinnc- Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) HARRISON ENTERPRISES INC 'Responsible Person's. Name: Responsible Person's Signature: Danielle Garcia Danielle Garcia CSLB License: 686310 Date Signed: 5/24/2012, 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-A0027043A-M2500001A-0000 Registration Date/Time: 2012/05/30 13:0.7:54 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009