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06-1571 (MECH)
4 P.O. BOX 1504 ^' . VOICE (760) 777-7012 78-495 CALLE TAMPICO • FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY'DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 4/18/06 Application Number: 06-00001571 Owner: Property Address: 55496_ SOUTHERN HILLS TOM BARRATT APN: 775-190-020- - - -55496 SOUTHERN HILLS Application description: MECHANICAL LA QUINTA, CA 92253 Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 5.894 r Y Contractor: 4 'Applicant: Architect or -Engineer': PALM DESERT AIR CONDITIONING 42081 BEACON HILL PALM DESERT, CA 92211 APR 1 006 (760)346-0677 LICENSED CONTRACTOR'S DECLARATION, hereby affirm under penalty of perjury that I -am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. _ License Class: C20 LicenseNo.: 374937 Date% Contractor: + OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 o the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: 1 _ 1 I; as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). 1 _ 1 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'ptojects with a contractor(s) licensed pursuant to the Contractors' State License Law.). 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 Lic. No.: 3.74937. CITY OP LA QUINTA -FINANCE - 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 mairitain 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 acid policy number are: - Carrier STATE FUND Policy Number 1795546-2006 1 certify.that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. '` i"'��4 Date:`"t- Applicant; WARNING: FAILURE TO SECURE WOR RS' 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 mode to theDirector of Building and Safety fora, 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 woik is not commenced within 180 days from date of issuance of such permit, or cessation of work for180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upon the above-mentioned property for inspection purposes. Data. Signature (Applicant or Agent): - Application Number . . . 06L00001571 Permit. . . MECHANICAL Additional -desc ., Permit, Fee . ' .. 37..50 ': Plan Check Fee— . 9.38 Issue Date Valuation 0 Expiration Date — 10/15/06 Qty Unit Charge.." Per Extension. BASE - FEE 15.0 0 1.00. 9.0000 EA MECH FURNACE <=100K 9.00 1.00 4.5000 EA MECH VENT INST/ DUCT ALT 4.50 "1.'0.0 9.0000 EA MECH APPL REP/ALT/ADD 9.00 Special Notes and Comments INSTALL ONE AMERICAN'STANDARD 3.0 TON 14 SEER 2 -STAGE GAS FURNACE & COIL - SPLIT HIGH EFFICIENCY,SYSTEM Fee summary' Charged Paid Credited Due Permit Fee Total .37.50 .00 .00 37.50 LQPERMIT - - Bin # City of La Quinta Building U Safety Division P.O. Box 1504,78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit .# 1 1 I Project Address:'Ja -" Owner's Name: A. P. Number: Address: Legal Description: Contractor: LdL4 25 ale, City, ST, Zip. Telephon Address:��� Project Description:�[�/ City, ST, Zip: Telephon .7lpD)� f��DG%� __ / . aO,See�. 07 S� Cao State Lic. # -3 3 7City. Lic. #:j� Arch., Engr., Designer: 4/14 Address: City, ST, Zip: Telephone: g n _ i• State Lic. #: Name of Contact Person: ae le Construction Type: Occupancy: Project type (circle.one): New Add'n Alter Repair Demo Sq. Ft.: # Sto• ries: / #Units: Telephone # of Contact Person %1p6) 3-;,/ -06 77 Estimated Value of Project:'" S eF as APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd TRACKING . PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance. Energy Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading. plan 2nd Review, ready for correctionsiissue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted. Grading IN HOUSE:- 'ro Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.LP.P.. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees 'Installation Certificate Prescriptive Method - HVAC -only Alteration CF -61R -ALT Project T' e: Date: fj ��v ©2005 CaICERTS Enforcement Agency Use Only Project Address: Climate Zone: Building Permit a Installing Contractor: Telephone: s�6•o6 � Plan Check Date ; Comp /i (� Field Check Date r IMPORTANT: This CF -6R form is only for use when an HVAC -only alteration is made to an existing home Use one form for each system being altered: This is system # of systems altered in this house. Copies to: Homeowner, HERS Rater, and Building Department List the specifications for the newly installed equipment. These must match the installed equipment exactly. Installed equipment must match type/location and meet or exceed efficiencies/R-values from CF -1 R. Equipment T e Manufacturer Model Number Efficiency Load"" Capacity— a aci —Furnace Furnace AFUEyO 7• Heat Exchanger N/A Heat Pump fan coil N/A Hydronic fan coil N/A Other FAU Describe Package gas/AC AFUE SEER Package heatpump HSPF SEER EER" A/C Condenser SEER,,(O,, O' 114' ,30,e gtyo Heatpump Condenser HSPF SEER Indoor DX coil EER" Hydronic coil Provide EER if needed for compliance (line 24 of CF -1 R -ALT). Installer must provide adequate documentation to verify EER. In some cases the specific furnace may need to be verified in order to achieve a specific EER. In some cases a time delay relay and/or TXV may need to ve verified in order to achieve a specific EER. " Loads are sensible for cooling. Capacities are sensible at design conditions for cooling and adjusted altitude, downflow, etc. output for heating. XV: ❑ If TXV is required by the CF -1 R form (line 23 on CF -1 R -ALT form), it has been installed and access has been provided for visual verification by HERS rater. Sampling is allowed for TXV verification. Entirely New Duct System: '(Line 5 of CF -1 R ALT) ❑ For Entirely new duct systems, the required leakage is 6% rather than 15% for altered systems. The alternative to duct sealing by increasing the efficiency of the equipment is not an option for entirely new ducts stems. I, the undersigned, verify that the equipment listed above is: 1) the actual equipment installed in the home; 2) equal to or more efficient than required by the Certificate of Compliance (CF -1 R -ALT Form); and 3) equipment that meets or exceeds the appropriate requirements for manufactured devices (Appliance Efficiency Standards), where applicable. I, the undersigned, verify that diagnostic test results listed on this form were performed in conformance with the requirements for compliance and that the newly installed or retrofitted mechanical system components conform with the Mandatory requirements specified in Section 150(m) of the 2005 Building Energy Efficiency Standards. Signed (Installer): Date: Notes: version Us -i U-Ub rage 1 or Z This form can only be used on projects being verified by CaICERTS certified raters. www.calcerts.com 4 Installation Certificate Prescriptive Method - HVAC -only Alteration CF -6R -ALT Project Title: 12_ Date: © 2005 CaICERTS IMPORTANT: This CF -6R form is only for use when an HVAC -only alteration is made to an existing home Use one form for each system being altered. This is system # of systems altered in this house. Copies to: Homeowner, HERS Rater, and Building Department Duct Leakage test Results If duct testing is required per CF -1 R -ALT form Step 1 - Pre-test: Leakage of the system before any alterations. This test isoptional and is only used for the 60% reduction option 1 Pre-test leakage : CFM25 2 Line 1 x 0.4 = [target for 60% reduction Step 2 - Determine Total System Fan Flow: Use any of these methods. Use values fore ui ment after alterations. 3 Cooling: Condenser tonnage: tons x 400 CFM/ton = JCFM 4 Heating: Furnace output: Btuh x .0217 CFM/Btuh JCFM 5 6 Measured: (refer to ACM Manual Appendix RE, section/4.1) = CFM Measurement method: ❑ flow hood lenum pressure matching ❑ flow grid Pd p 7 Totals stem fan flow value to be used: 2-:04 JCFM may use highest of lines 3, 4, or 5. Step 3 - Determine Targets: 8a Total System fan flow (line 7 from above) x 0.06 = ICFM25 = 6% leakage target (new duct systems) Bb Total System fan flow (line 7 from above) x 0.15 = CFM25 = 15% leakage target JTotal 9 System fan flow line 7 from above x 0.10 = ICFM25 = 10% leakage to outside target Step 4 - Alterations: Must be consistent with the CF -1 R form. 10 ❑ eal all new connections with approved materials. 11 ❑ newt constructed ortions of the s stem can have unducted buildin cavities to conve s stem air. rNo 12 ❑ adding or replacing more than 40 feet of duct, insulate new ducts per package D for that climate zone Step 5 - Final Leakage (regular duct leakage test, for 15% total and 60% reduction) 13 leakage = I /:? ? ICFM25 refer to 2005 ACM appendix RC, Sections RC 4.3.1 14a ❑ If line 13 is less than line 8a house passes the 6% leakage requirement, Go to Step 9. 14b 9 If line 13 is less than line 8b house passes the 15% leakage requirement. Go to Step 9. 15 ❑ If line 13 is less than line 2 house passes the 60% reduction requirement, continue. 16 ❑ If either of lines 14a, 14b or 15 are checked, HERS verification is required. Sampling can be used. 17 ❑ ilf line 15 is checked, but not 14a or 14b, Smoke Test and Visual Inspection of Accessible Duct Sealing is required. Go to Step 8 Step 6 - Leakage to Outside: Similar to a regular duct blaster test but the house is pressurized to 25 pascals at the same time. 18 leakage = CFM25 refer to 2005 ACM appendix RC, Sections RC 4.3.3 19 ❑ If line 18 is less than line 9 house passes the 10% leakage to outside requirement. 20 ❑ If line 19 passes, HERS verification is required. Sampling can be used. Step 7 - If the house does not pass any of lines 14, 15 or 19. 21 ❑ ISmoke Test and Visual Inspection of Accessible Duct Sealing is required. See Step 8. 22 ❑ 1 Install required label per ACM Appendix RC, Sections RC.4.3.5. Step 8 - Smoke Test and Visual Verification See 2005 Residential ACM Appendix RC Sections RC 4.3.5-7 23 ❑ Perform smoke test per ACM Appendix RC Sections RC 4.3.6. 24 ❑ 1 Perform Visual Inspection and repair of excessively damaged ducts per ACM Appendix RC Sections RC 4.3.7. 25 ❑ ISeal register boots to surrounding material per ACM Appendix RC, Sections RC 4.3.7. HERS Verification 26 ❑ If line 14 is checked. 15% leakage to be verified by HERS rater. Sampling is allowed. 27 ❑ If line 15 is checked. 60% leakage reduction to be verified by HERS rater (post test only) AND Smoke Test and Visual Verification to be performed by HERS Rater. Sampling is allowed. 28 ❑ If line 19 is checked. 10% leakage to outside to be verified by HERS rater. Sampling is allowed. 29 ❑ If none of lines 14, 15 or 19 are checked Smoke Test and fix all accessable leakes. No sampling allowed. Sampling - Only if house passes on lines 14, 15 or 19. 30 ❑ 1.) Homeowner chooses to be put into a group of homes for random third party HERS sampling. 2.) Homeowner, installer and rater must sign the three -party agreement. 3. All above tests must be completed by the installer or their representative, not the third party rater. No Sampling - House does not pass by lines 14, 15 or 19; OR homeowner chooses not to be part of a sample group 31 ❑ 1.) House to be tested by a third party HERS rater selected by installer. 2.) Homeowner, installer and rater must sign the three -party agreement. 3.) All above tests may be completed by the installer or their representative, and then verified by a third party rater. OR all above tests may be performed solely by the third party rater. 32 ❑ 1.) House to be tested by third party HERS rater selected by homeowner. 2.) All above tests may be completed by the installer or their representative, and then verified by a third party rater. OR, all above tests may be performed solely by the third party rater. Version 03-10-06 Page 2 of 2 This form can only be used on projects being verified by CalCERTS certified raters. www.calcerts.com ,Work Order' - Palm Desert Air Conditioning& Heating. Company 42-081 Beacon Hill Palm'Desert CA 92211 760-346-0677 FAX: 760-346-5200 95-3343831 Service At: Customer # 102961 ' - t. Bill To: Customer # 102961 Rating: BARRATT, MR TOM 760-399-9359 BARRATT, MR TOM 503-507-0328 CELL 55-496 SOUTHERN HILLS 3414 DEER.LAKE CIR. S.E. LA QUINTA CA 92253 LATHAM OR 97301 , Type: S/S Open Balance: Source: REF Payment Method: MASTER CARD, NET30 Zone: LQ Map: PGA` Credit Limit: Skill: Tax: _ Installation Customer . Directions JIM CARPENTER 333-2959 ' - ENTER STADIUM GATE 20X30X1-1, 14X25X1-1. ' 08/10/05 PLEASE SPECIFY WHICH EQUIP. WAS REPLACED. KIMBERLY ` Instructions INSTALL ONE (1) AMERICAN STANDARD (3.0 TON) 14.00 SEER R-41 OA, TWO STAGE GAS FURNACE AND COIL, ONE (1) WHITE RODGERS PROGRAMMABLE THERMOSTAT, ONE (1) ELECTROSTATIC + FILTER. PERFORM PRE & POST DUCT LEAKAGE TESTING, SEAL DUCTS AS MUCH AS POSSIBLE. WARRANTY: FIVE (5) YEAR PARTS &LABOR. CUAC MODEL NO. 4A7A4036B 1000AA. SERIAL NO.60248EEII F FAU MODEL NO. AUD080R936K5 . SERIAL NO. 6094S661G COIL MODEL -NO. 2XUC37/80 SERIAL NO. LMC080503 TOTAL DUE: $ 5,894.00 04/05/06 SCHED. 04/10/06 8-9 AM. KIMBERLY NOTE: DUCT REPAIR ON 5.0 TON SACH. Call Info Job Info Call No.: 1.23868 Booked by: KGALINDO • Job No.: 123868 Taken: 4/5/06 2:51 PM Type: ISAC Booked Date: 4/10/06. Class: ti REPLACEMENT Taken by: KGALINDO . Scheduled: 4/10/06 - 8:OOAM Sched by: KGALINDO Type: ISAC Cust PO: Pri Level: 2 �; , , Ld.Src: LT -TC SalesPerson: ROB Eq.Age: Y LS Ref: 11 - 1 20X30X 1 ESF Loc: SAC ' Contact: JIM CARPENTER AMST 2A7A2060B1000AA Equipment: V M10YR-P 07/05/2015' " Assignments Employee LIN JUAN TaskCode Scheduled Time 8:00:00 AM 8:00:00 AM' , Equipment r Warranties , Type Sys Mfg Model # Serial # Age Type Parts Ends Labor Ends CUAC 1 CAR- 38BRB036300 3396E79230 11 Filters: - Loc: SAC FAU 1 CAR 58P4V07012 2896AI1582'- 11 Filters: 1 20X30X 1 ESF Loc: SAC ' CUAC 2 AMST 2A7A2060B1000AA 5025Y382F V M10YR-P 07/05/2015' Certificate of Compliance Prescriptive Method - HVAC -only Alteration CF -1 R -ALT Project e: Date: �v v © CaICERTS 2005 Enforcement Agency Use Only Prt Ad�SS: 21 JAII Cllmat e: Building Permit # Docume tionA r: Telephone: 4z 7 Plan Check Date gmga�ny me: &- d& / a-16 IMPORTANT: Field Check Date This CF -1 R -ALT form is only for use when an HVAC -only alteration is made to an existing home Use one form for each system being altered. This is system # of systems altered in this house. Check all lines that apply, Check only lines that apply. Scope of Alterations: 1 ❑ An Air Handler is to be installed or replaced. Duct sealing to be determined. Continue to next line. 2 ❑ A Furnace Heat exchanger is to be installed or replaced. Duct sealing to be determined. Continue to next line. 3 ❑ An outdoor condensing unit is to be installed or replaced. Duct Sealing and/or TXV(RCA) to be determined. Continue to next line. 4 ❑ A cooling or heating coil is to be installed or replaced. Duct Sealing and/or TXV(RCA) to be determined. Continue to next line. 5 ❑ More than 40 feet of new or replacement duct are to be installed in uncondition0 trued space. Duct sealing to be determined. ❑ Check here if the entire duct system is also to be new or replaced. Continue to next line. 6 ❑ If none of lines 1-5 are checked, neither Duct Sealing nor TXV(RCA) are required. Go to Section 5. Section 1 - Duct Sealing (Only if any of Lines 1 2 3 4 or 5 are checked. Skip if Line 6 is checked. 7 ❑ This system is in Climate Zone 1, 3, 4, 5, 6, 7, or 8. No duct sealing is required. Go to Section 2. 8 ❑ This system has less than 40 feet of ducts in unconditioned space. No duct sealing is required. Go to Section 2. 9 ❑ This system was previously sealed and tested, and was certified by a HERS rater. No duct sealing is required. Attach previous CF -4R form. Go to Section 2. 10 ❑ This ducts stem is sealed or insulated with asbestos. No duct sealing is required. Go to Section 2. Note: If the entire ducts stem is to be new or replaced, Lines 11-14 do not apply. 11 ❑ In Climate Zones 2 12 and 16: An 0.92 AFUE furnace will be installed in lieu of duct sealing and TXV if applicable). 12 ❑ In Climate Zones 10, 13 and 15: An SEER 14 AND EER 12 condenser will be installed with TXV(RCA) AND added duct insulation R-4 wrap on existing ducts, R-8 new ducts in lieu of duct sealing. Go to Section 2. 13 ❑ In Climate Zones 9, 10, 11, 13, 14, or 15: An SEER 14 AMQ EER 12 condenser will be installed with TXV(RCA) AND a 0.92 AFUE furnace will be installed in lieu of duct sealing. Go to Section 2. 14 ❑ In Climate Zones 2, 9, 11, 12, 14 or 16: An SEER 14 AMD EER 12 condenser will be installed with TXV(RCA) AND an 0.82 AFUE furnace will be installed with increased duct insulation in lieu of duct sealing. Go to Section 2. 15 ❑ None of lines 7-14 above are checked. Duct Sealing is Required. Continue. Section 2 - TXV(RCA) (Only if Lines 3 or 4 are checked, otherwise got to Section 3 16 ❑ The system being altered is a package unit. No TXV(RCA) is required. Go to Section 3. 17 ❑ This system is in Climate Zone 8 and a 14 SEER air conditioner or 0.82 AFUE furnace is being installed. No TXV(RCA) is required. Go to Section 3. 18 ❑ This s stem.is in Climate Zone 1 3 4 5 6 or 7. No TXV(RCA) is required. Go to Section 3. 19 ❑ This system is in Climate Zone 16 and line 14 is not checked. No TXV(RCA) is required. Go to Section 3. 20 ❑ This s stem is in Climate Zone 16 and line 14 is checked and not line 16. TXV(RCA) is required. Go to Section 3. 21 ❑ This system is in Climate Zone 2 or 8-15 and line 11, 16 or 17 is not checked. TXV(RCA) is required. Go to Section 3. Section 3 - HERS Rater verification 22 ❑ If line 15 is checked, HERS verification is required for Duct Sealing. 23 ❑ If line 12, 13, 14, 20 or 21 are checked and not line 16 or 17, HERS verification is required for TXV(RCA). 24 ❑ If line 12, 13 or 14 are checked, HERS verification Is required for 12 EER. Section 4 - Equipment Efficiencies 25 ❑ If lines 11, 12, 13, 14 or 17 are checked, upgraded equipment efficiencies are required. List in Section 6. Section 5- Duct R -Values 26 ❑ Ilf more than 40 feet of duct is being installed or replaced, duct R -value must meet or exceed Package D requirements. 27 ❑ Ilf less than 40 feet of duct is being installed or replaced, duct R -value must meet or exceed R-4.2 Section 6 - see next page Version 03-10-06 Page 1 of 2 This form can only be used on projects being verified by CaICERTS certified raters. www.calcerts.com Certificate of Compliance Prescriptive Method - HVAC -only Alteration CF -1R -ALT Project Titl D;4!& © CaICERTS 2005 IMPORTANT: This CF -1 R -ALT form is only for use when an HVAC -only alteration is made to an existing home Use one form for each system being altered. This is system # of systems altered in this house. Section 6 - Minimum Requirements for Equipment to be Installed/Altered. Installed equikme5 must match type/location and meet or exceed efficiencies/R-values. 2$ Configuration: Xplit system ❑ Package Unit 29 4K Air Handler XGas furnace, AFUE: g 91 ❑Heatpump FAU ❑Hydronic FAU ❑Other 30 ❑ Heat Exchanger 31 W Outdoor Condensing Unit A/C ❑Heatpump kfriciency SEER/HSPF: 400 JEER if re d : 32 ❑ Cooling or heating coil ❑A/C ❑Heatpump ❑Hydronic 33 121r Duds Location:Length (ft): R -value: All mandatory measures apply to any altered component. See MF -1 R - ALT form. Compliance Statement: This certificate of compliance lists the building features and specifications needed to comply with Title 24, Parts 1 and 6 of the California Code of Regulations, and the administrative regulations to implement them. This certificate has been signed by the individual with overall project responsibility. The undersigned recognizes that compliance using duct sealing, verification of refrigerant charge, and TXV require installer testing and certification and verification by an approved HERS rater. Home Owner or Authorized Agent Documentation Author Name: Name: Address: Compan ame: Q G &Xd'er'l City/State/Zip: Address: Phone: City/St /Zip. Ph 7h7 '3'(11(0 - oG Signature: Signature: Enforcement Agency (Building Department) Notes/Com a s: Name: Title: Department: Phone #: Fax #: Signature or Stamp: Required forms: CF -1 R -ALT: by anyone. Required at time of permit application. Copies to home owner, enforcement agency, HERS rater. CF -6R -ALT: by installing contractor. Required to close permit. Copies to home owner, enforcement agency, HERS rater. CF -4R -ALT: by HERS rater. Required to close permit. Copies to home owner, enforcement agency, installer. The CF -4R forms for a sample group shall not be released until all testing and verification is completed and passed for the entire group. Version 03-10-06 Page 2 of 2 This form can only be used on projects being verified by CaICERTS certified raters. www.calcerts.com 5 CaICERTS - Certificate Page 1 of 2 4,'' CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING (Page i of 8) CF -4R 55496 Southern Hills Project Add TI Con dor Con Pa Van Vly Palm Desert A/C - Heating / 374937 Contractor Name / License No. 06-00001571 Telephone Permit Number 760-777-1724 23202 Telephone Sample Group Number —May 5, 2006 CC14-1798363778 Date Certificate Number Firm: Air Experts Air Conditioning HERS Provider:CaBCERTS Street Address: PO Box 94 City/S ote/zip: La Quinta 'CA 192247 Copies to: Homeowner, BIERS Provider and Buildlnc D–o©art_m— _ =it HERS RATER COMPLIANCE STATEMENT ❑ Tested R Approved as part of Sample testing, but wag not tested. As the HERS rater providing diagnostic testing and field verification, I certify that the house identified on this form complies with the diagnostic tested compliance requirements as checked on this form. The HERS rater must check and verify that the new distribution system is fully ducted and correct tape is used before a CF -411 may be released on every tested building. The HERS rater must not release the CF -411 until a properly completed and signed CF -611 has been received for the sample and tested buildings. The installer has provided a copy of the CF -611 (Installation Certificate). New Distribution system Is fully ducted (i.e., does not use building cavities as plenums or platform returns in lieu of ducts). New systems where cloth backed, rubber adhesive duct tape is installed, mastic and drawbands are used in combination with cloth backed, rubber adhesive duct tape to seal leaks at duct connections. MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT: NEW CONSTRUCTION Duct Pressurization Test Results (CFM @ 25 Pa) MeasuredValues - 1 N/A 2 Fan Flow: Calculated (Nominal 0 Cooling © Heating) or 0 Measured Enter Total Fan Flow in CFM: Not Tested 3 N/A N/A ALTERATIONS: Duct System and/or HVAC Equipment Change -Out 4 Enter Tested Leakage Flow in CFM from CF -6R: Pre -Test of Existing Duct System Prior to Duct System Alteration and/or Equipment Change -Out. Not Tested 5 Enter Tested Leakage Flow in CFM: Final Test of New Duct System or Altered Duct System for Duct System Alteration and/or Equipment Change -Out. Not Tested 6 Enter Reduction in Leakage for Altered Duct System Line 4 - Line 5 [ ] - (Only if Applicable) Not Tested 7 Enter Tested Leakage Flow in CFM to Outside (Only if Applicable) Not Tested 8 Entire New Duct System - Pass if Leakage Percentage <= 6% [ 100 x ( Line 5 / Line 2 )]: Not Tested ❑ Pass ❑ Fail TEST OR VERIFICATION STANDARDS: For Altered Duct System and/or HVAC Equipment Change -Out, use one of the following four Test or Verification Standards for compliance: 9 Pass if Leakage Percentage <= 15% [ 100 x ( Line 5 / Line 2 )]: Not Tested © Pass ❑ Fail 10 Pass if Leakage to Outside Percentage <= 10% [ 100 x ( Line 7 / Line 2 )]: Not Tested ❑ Pass ❑ Fall 11 Pass if Leakage Reduction Percentage >= 60% [ 100 x ( Line 6 ( Line 4 )] Not Tested and Verification by Smoke Test and Visual Inspection ❑Pass ❑ Fail SZ Pass if Sealing of all Accessible Leaks and Verification by Smoke Test and Visual Inspection L ❑ Pass ❑ Fail Pass if One of Lines #9 through #12 pass © Pass ❑ Fail TiFiTi1 (:E'. i' i(:r_if(;.(:3i F,�FEfnf�ir(:vi i iiiSE'.EiFF=1ii(EiI(ji)1%_.ifiS�=I_j 11.4h / iLl�it�S a CaICERTS - Certificate Page 2 of 2 ' � CERTIFICATE OF FIELD VERIFICATION 8t DIAGNOSTIC TESTING. (Page 3-4 of 8)- CF -4R 55496 Southenn Hills Palm Desert A/C - Heating / 374937 Project Address Contractor Name / License'No. 06-00001571 4 Contra Con Telephone Permit Number Paul V VI 760-777-1724 23202 ' HERS Ra r Telephone Sample Group Number . May 5 2006 CC14-1798363778 Certifying Vnature Date Certificate Number Firm: Air Experts Air. Conditioning HERS Provider:Ca10ERTS Street Address: PO Box 94 City/State/Zip: La Quinta / CA / 92247 Copies to: Homeowner, HERS Provider and Building Department t This CF -4111 has been registered with the CaICERTSO registry in accordance with the Title 24 & Title 20 of the CCR. C_alCERTSO is an approved HERS provider by the California Energy Commission. HERS RATER COMPLIANCE STATEMENT The house was ❑ Tested 2 Approved as part of sample testing, but was not tested. , As the HERS rater providing diagnostic testing and field verification, I certify that the house Identified on this form complies with the dia nostic tested compliance requirements as checked on this form. [' The installer has provided a.copy of.the CF -611 (Installation Certificate). . LV?THERMOSTATIC EXPANSIOU VALVE TXV Access is provided for inspection. The'procedure shall consist of visual verification that the.TXV is installed on the system and installation of the specific equipment shall be verified. F HVAC System TXV 0 Pass ❑ Fall d http://calcerts.com/cf4r_print_certificate.cfin?RequestTimeout=100000&lots=23196 5/4/2006 .A i d http://calcerts.com/cf4r_print_certificate.cfin?RequestTimeout=100000&lots=23196 5/4/2006