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11-1242 (MECH)P.O. BOX 1504 78=495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Applicant: Architect or Engineer: BUILDING & SAFETY DEPARTMENT BUILDING PERMIT ---------- 7 -------------------------- 7 ------------- LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjurynat I am licensed rider provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Busil(,.e� and Profes o Is Code, and my License is in full force and effect. License Class: C20 License No.: 791121 ate: — _- — f ntractor. LDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following -reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the .permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: (_ 1 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). (_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). ( 1 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 Owner: LUBAS DENNIS/KNASIAK LEO 78515 AVENIDA ULTIMO LA QUINTA, CA 92253- Contractor: UNIVERSAL MECHANICAL 74698 CANDLEWOOD DRIVE PALM DESERT, CA 92260 (760)851-9679 LiC..No.: 791121 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 11/17/11 ----------------------------------------------- WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor . Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier EXEMPT Policy Number EXEMPT I certify that, in the pe rmance of the work for which this permit is issued, I shall not employ any person in any mann r as to become sub' t the workers' compensation laws of California, and agree that, if I s oul con sub jec o e workers' compensation provisions of Section 73700 of the abor C I_fo m I with those provisions. ate: ' _f - _) f p ant: WARNING: FAILURE TO S ORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN. SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT - IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. 1. Each person upon whose behalf this application is made, each person at whose request and for whose.benefit work is performed under or pursuant to any permit issued as a result of this application, the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I 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 an tate laws relating to building construction, and hereby authorize representatives 7ofth*'county to enter upon a above-mentioned property for inspection purposes. SWnature (Applicant or Agent): Application Number: X11-00001242 Property Address: 78515 AVENIDA ULTIMO APN: 770 -091 -002 - Application description: MECHANICAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 5000 Applicant: Architect or Engineer: BUILDING & SAFETY DEPARTMENT BUILDING PERMIT ---------- 7 -------------------------- 7 ------------- LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjurynat I am licensed rider provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Busil(,.e� and Profes o Is Code, and my License is in full force and effect. License Class: C20 License No.: 791121 ate: — _- — f ntractor. LDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following -reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the .permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: (_ 1 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). (_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). ( 1 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 Owner: LUBAS DENNIS/KNASIAK LEO 78515 AVENIDA ULTIMO LA QUINTA, CA 92253- Contractor: UNIVERSAL MECHANICAL 74698 CANDLEWOOD DRIVE PALM DESERT, CA 92260 (760)851-9679 LiC..No.: 791121 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 11/17/11 ----------------------------------------------- WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor . Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier EXEMPT Policy Number EXEMPT I certify that, in the pe rmance of the work for which this permit is issued, I shall not employ any person in any mann r as to become sub' t the workers' compensation laws of California, and agree that, if I s oul con sub jec o e workers' compensation provisions of Section 73700 of the abor C I_fo m I with those provisions. ate: ' _f - _) f p ant: WARNING: FAILURE TO S ORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN. SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT - IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. 1. Each person upon whose behalf this application is made, each person at whose request and for whose.benefit work is performed under or pursuant to any permit issued as a result of this application, the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I 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 an tate laws relating to building construction, and hereby authorize representatives 7ofth*'county to enter upon a above-mentioned property for inspection purposes. SWnature (Applicant or Agent): Application Number . . . . . 11-00001242 Permit . . . MECHANICAL' Additional desc .. Permit Fee . . 48.00. Plan Check Fee 12.00 Issue Date . . . . Valuation 0 Expiration Date 5/15/12 Qty Unit Charge Per Extension BASE FEE 15.00 2.00 16.500.0 EA MECH B/C >3-15HP/>100K-500KBTU 33.00 ---------------------------------------------------------------------------- Special Notes and Comments HVAC REPLACEMENT, 2 16 SEER CONDENSERS & COILS. 2010 CODES. ------------------=--------------------------------------.-----------=------- Other Fees . . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged Paid Credited Due Permit Fee Total 48.00 .00 .00 48.00 Plan. Check Total 12.00 .00 .00 12.00 Other Fee Total 1.00 .00 .00. 1.00 Grand Total .61.00 .00 .00 61.00 LQPERMIT Sinn lified Priescri tive Cliinatc Zones 10.to I5* of Compliance: 2( Residential HVAC Alterations CF-lR-ALT=HVAC. Jire Address: �] Q Enforcement Agency: Date: Permit #: Equipment T ❑ Packaged Unit List Minimum Efficient Z Duct insulation requirement Conditioned Floor Area Thermostat ❑ Setback ❑ Fumace ❑ AFUE_ ❑ COP Over 40 ft of ducts added or ❑ Indoor Coil Condensing.11nit 'K _ SEER� ❑ HSPF _ replaced in unconditioned space ❑ R 6 Served by system (Ifnot a►readv Other bbEER ❑ Resistance (CZ l0-13) ❑ R 8 (CZ /4-1 SJ sf present, must be installed) 1. Equipment Type: Choose the equipment being installed: if more than one system, use another CF -1 R -ALT -HVAC for each system. 2. Minimum Equipment Effu:iencies: 13 SEER, 78.16 AFUE, 7.7HSPFfortypical 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 A conducted. 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 CF4R forms (no hand filled CF4Rs allowed) are filled out and ied. Beginning October 1, 2010, a registered co of the CF -1R and CF -6R shall also be on site for final Inspection. l HVAC Changeout Required Forms: • All HVAC Equipment replaced CF-61kforms: MECH-04, MECH-2I-HERS and (for split systems) MECH- 25 -HERS CF -4R forms: MECH- 21 and fors lit stems MECH-25 • Condenser Coil and/or • Indoor Coil and/or CF -6R forms: MECH-2I-HERS and (for split systems) MECH- 25 -HERS • Furnace CF -4R forms: MECH- 21 and (for split systems) MECH-25 For Split Systems: Duct leakage < 15 percent; RC, CCA > 300 CFM/ton(Minimum Air Flow Requirement), TMAH For Packaged Units: Duct leakage < 15 percent Exempted from duct leakage testing if: ❑ 1 Duct system was documented to have been previously sealed and confirmed through HERS verification, or ❑ 2. Duct systems with less than 40 linear feet in unconditioned space, or ❑ 3. Existing ducts stems are constructed, insulated or sealed with asbestos ❑ 2. New HVAC System Required Forms: • Cut s: al Chang outducting with new CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS ducts: (all new ducting and all CF -4R forms: MECH 20-, and fors lit s sterns MECH-22, and MECH 25 new equipment) ( split Y ) For Split Systems: Duct leakage < 6 percent; RC, CCA > 350 CFM/ton, FWD, TMAH, STMS, and either HSPP or PSPP. For Packaged Units: Duct leakage <6 percent ❑ 3. New Ducts with Replacement Regttfred, Forms: • Includes replacing or installing all new ducting CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-25-HERS and/or outdoor condensing unit and/or indoor CF411 forms: MECH-20 and (for split systems) MECH-25 coil and/or furnace. Not all equipment changed. For Split Systems: Duct leakage < 6 percent, RC, CCA >_ 300 CFMAon, TMAH For Packaged Units: Duct leakage <6 percent ❑ 4. New Ducting over 40 feet Required Forms: • Includes adding or replacing more than 40 linear feet of duct in unconditioned s ace. CF -611 forms: MECH-04, MECH-2I-HERS CFAR forms: MECH-21 I For split system or packaged units: Duct leakage < 15 percent ❑ EXCEPTION: Existing ducts sterns constructed, insulated or sealed with asbestos. Contractor (Documentation Author's /Responsible Designer's Declaration Statement) • 1 certiffi, that this Certificate of Compliance documentation is accurate and complete. • 1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of Compliance. I certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24, Parts I and 6 of the California Code of Regulations. • The design features identif+ed on this Certificate of Compliance are consistent with the information umented n o r applicable compliance forms, worksheets. calculations, plans ands specifications submitted to the enforcement agency for a royal with the i a lits[ Name: � �� on 5 Signature: -- Company: ung vyf5nl f'�e�yghl�,�� '- Address: 7 �I t5 ✓►�t t^�,e (� License: III 2-1 rc ity/Statc/Zip: R i II Sz Phone: `71:, q 0 -� S � — 7 4, 7 9 2008 Residential Compliance Forms March 2010 Si hip fified-Prescri tive'Certi4ieate of Coin liamce: 2008 Residentiai. HVACA[ierations CF-IR-ALT=HVAC'. Climate Zones 10 to IS En orcement Agency: f Dare: Permit #: o t Equipment T List Minimum Efficienc Z Conditioned Floor Duct insulation requirement Area .Thermostat ❑ Packaged Unit ❑ Furnace ❑ AFUE ❑ COP Over 40 ft of ducts added or ❑ Setback ❑ Indoor Coil replaced in SEER ❑ HSPF unconditioned space Served by system (If not alreadv Condensing Unit ❑ EER ❑ R 6 (CZ 10-13) ❑ Resistance sf present, must- be ❑ Other ❑ R 8 (CZ 14-15) Installed) 1. Equipment Type: Choose the equipment being installed: if more than one system, use another CF -1 R -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 the fortis be left of shall 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 CF4R forms (no hand filled CF-4Rs allowed) are filled out and si ed. Besinning October 1, 2010 a reeistered copy of the CF -1R and CF -6R shall also be on site for final Inspection. 1. HVAC Changeout Required Forms: • All HVAC Equipment replaced CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH- 25 -HERS CF -4R forms: MECH- 21 and fors lits stems MECH-25 • Condenser Coil and /or • Indoor Coil and/or CF -6R forms: MECH-2I-HERS and (for split systems) MECH- 25 -HERS • Furnace CF4R forms: MECH- 21 and (for split systems) MECH-25 For Split Systems: Duct leakage < 15 percent; RC, CCA > 300 CFM/ton(Minimum Air Flow Requirement), TMAH For Packaged. Units: Duct leakage < 15 percent Exempted from duct leakage testing if: ❑ 1 Duct system was documented to have been previously sealed and confirmed through HERS verification, or ❑ 2. Duct systems with less than 40 linear feet in unconditioned space, or ❑ 3. Existing ducts stems are constructed. insulated or sealed with asbestos ❑ 2. New HVAC System Required Forms: • Cut in or Changeout with new ducts: (all new ducting and all CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS new equipment) forms:CF-4R fors: MECH 20-, and (for split systents)MECH-22, and MECH 25 For Split Systems: Duct leakage < 6 percent; RC, CCA > 350 CFM/ton, FWD, TMAH, STMS, and either HSPP or PSPP. For Packaged Units: Duct leakage <6 percent ❑ 3. New Ducts with Replacement Required Forms: • Includes replacing or installing all new ducting CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-25-HERS and/or outdoor condensing unit and/or indoor CF4R fortes: MECH-20 and (for split systems) MECH-25 coil and/or furnace. Not all equipment changed. For Split Systems: Duct leakage < 6 percent, RC, CCA > 300 CFM/ton, TMAH For Packaged Units: Duct leakage < 6 percent ❑ 4. New Ducting over 40 feet Required Forms: • Include, adding or replacins more than 40 linear feet of duct in unconditioned s ace. CF -611 forms: MECH-04, MECH-2I-14ERS CF -4R forms: MECH-21 For split system or packaged units: Duct leakage < 15 percent ❑ EXCEPTION: Existing ducts stems constructed, insulated or sealed with asbestos. Contractor (Documentation Author's /Responsible Designer's Declaration Statement) • I certiF• 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 Ne design identified on this Certificate of Compliance. I cen ifY that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24, ['arts I and 6 of the California Code of Regulations. • i he dem.-n features identified on this Certificate of Compliance are consistent with the information d rine tedforms.n other applicable compliance fors. worksheets. calculations, plans ands cifications submitted to the enforcement a enc for roval with the perm n Name: / i n l ya5tA ch,► e / Signature: Company: Date: Address: / �j `J License: ^� (� I' Z Citi'/Statc2ip: M e SoV } 2 Z �7 / I Phone: -76-,0 N b'7 9 [UUrs Kestaenttal C ompliance Forms March 2010 Bin # . City Of La Qufn tQ ' . Miding & Safety. Division P.O. Box 1504,78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # �L \ Project Address: 7 9 Aver i 1 im c Owner's Name: n n r S Lo &PS, A. P. Number: Address:.-eni S I/ 14 i"1 , ✓I b Legal Description: Contractor.I e %C!9 1 City, ST, Zip: : > ats::::;.•:" :t•�wxs:z<:hs»>;;-• Telephone: / y>a:111 Address: `7 (./ 8 51� h Project Description: City, ST, Zip: �►� IM 0 % _<,e/'+A 2- f' Ea S EE2 (!-a n �i P/L e-, Telephone: p �1 -C� 4 �..a.{.<x State Lic. # : 2 1 City Lic. #; Arch., Engr.,' Designer: Address: City, ST, Zip. Telephone State Lic. #: Name of Contact Person: \�hi::.:+,.{fit:- : ti^T::}i:y�t YC• 3 r`:''t+::>{>?:;x ancy: Construction Type: Occup, . Pro's circle one): New Add'n Alter Repair Demo Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS UNE # Submittal Req'd Recd TRACKING PERMIT FEES Pian Sets Plan Check submitted Item Amount Structural Cales. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance 'hide 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2.1 Review, ready for correctionstissue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up SM.I. H.OA. Approval Plans resubmitted Grading IN HOUSE:- Review, ready for correctionstiissue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees xrY >TALLATION CERTIFICATE CF-611-MECH ace Conditioning Systems, Ducts and Fans (Page 1 o e Address:._,__ Enforcement Agency: Permit Number:' -515 Ave Ultimo, La Quinta.CA 92253 (System -1)__ City of.La Quinta 11-1242 Space Conditioning Systems - Heating Equipment Equip Type (package- heat pump) w ARI Reference Number2 # of Identical Systems Efficiency (AFUE, etc.)1, 3 (>=CF -IR value)4 Duct Location (attic, crawl- space, etc.) Duct R -value Heating Load (kBtu/hr) Heating Capacity (kBtu/hr) Equip 1 (SEER Location xrY >TALLATION CERTIFICATE CF-611-MECH ace Conditioning Systems, Ducts and Fans (Page 1 o e Address:._,__ Enforcement Agency: Permit Number:' -515 Ave Ultimo, La Quinta.CA 92253 (System -1)__ City of.La Quinta 11-1242 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 -IR value)4 Duct Location (attic, crawl- space, etc.) Duct R -value Heating Load (kBtu/hr) Heating Capacity (kBtu/hr) Equip 1 (SEER Location Type �' • t` . and EER) (attic, (package 3 ARI # of 1, 3 crawl- Cooling Cooling heat CEC Certified Mfr. Name Reference Identical (>=CF -1R space, Duct Load Capacity pump) `w .and Model Number: Number2 Systems value)4 etc.) R -value (kBtu/hr) (kBtu/hr) Split CA/C,, Goodman " SSX160591' - 1 :16 SEER 13 EER ` -Attic -40- - — -5 Tons— Cooling Equipment O 1. If project is new construction, see'Footnotes to Standards Table 151-8 and Table 151-C for duct ceiling alternative compliance.( , 2. ARI Reference Number can be found by entering the equipment model number at . http://www.aridirectory.orglarilac.php# 3. Listed efficiency on this page must be greater than or equal ( ? ) to the value shown on the CF -1R form. 4. When CF -1R 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. 0 §150(i): Setback Thermostat on all applicable heating and/or cooling systems meet the requirements of §112(c). ® §150(j)2: Pipe insulation for cooling system refrigerant suction, chilled water and brine lines meets minimum requirements of Table 150-B and includes a vapor retardant or is enclosed entirely in conditioned space. Reg: 211-A0060383B-M0400001B-0000 Registration Date/Time: 2011/11/22 14:43:05 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009, ,. Efficiency Duct Equip 1 (SEER Location Type �' • t` . and EER) (attic, (package 3 ARI # of 1, 3 crawl- Cooling Cooling heat CEC Certified Mfr. Name Reference Identical (>=CF -1R space, Duct Load Capacity pump) `w .and Model Number: Number2 Systems value)4 etc.) R -value (kBtu/hr) (kBtu/hr) Split CA/C,, Goodman " SSX160591' - 1 :16 SEER 13 EER ` -Attic -40- - — -5 Tons— '�.. 91�"i✓'..�-s'- '3y.- L: .,`" � w'/=�..i-- _ ..."....E 4.--�. I' 3 '""t. �--.. ?+"^ ,`y�f 7�,4• �r!1 ',R_!; `�S O 1. If project is new construction, see'Footnotes to Standards Table 151-8 and Table 151-C for duct ceiling alternative compliance.( , 2. ARI Reference Number can be found by entering the equipment model number at . http://www.aridirectory.orglarilac.php# 3. Listed efficiency on this page must be greater than or equal ( ? ) to the value shown on the CF -1R form. 4. When CF -1R 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. 0 §150(i): Setback Thermostat on all applicable heating and/or cooling systems meet the requirements of §112(c). ® §150(j)2: Pipe insulation for cooling system refrigerant suction, chilled water and brine lines meets minimum requirements of Table 150-B and includes a vapor retardant or is enclosed entirely in conditioned space. Reg: 211-A0060383B-M0400001B-0000 Registration Date/Time: 2011/11/22 14:43:05 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009, INSTALLATION CERTIFICATE CF-6R-MECH-0 Space Conditioning Systems, Ducts and Fans (Page 2 of 2) Site Address: Enforcement Agency: Permit Number: 78-515 Ave Ultimo, La Quinta CA 92253 (System 1) 1 City of La Quinta 11-1242 Ducts and Fans §150(m): Duct and Fans R 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, end rely 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 R 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. R 2D. Joints and seams of duct systems and their components shall not be sealed with cloth back rubber adhesive duct tapes unless such tape is used in combination with mastic and draw bands. * 7. Exhaust fan systems have back draft or automatic dampers. * 8. Gravity ventilating systems serving conditioned space have either automatic or readily accessible, manually operated dampers. F5 Protection of Insulation. Insulation shall be protected from damage, including that due to sunlight, moisture, equipment maintenance, and wind. Cellular foam insulation shall be protected as above or painted with a coating that is water retardant and provides shielding from solar radiation that can cause *degradation-of.the material: © 10. Flexible ducts cannot have porous inner cores. DECLARATION STATEMENT j . I'certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. . I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized representative of the person responsible for construction (responsible person). . I certify that the installed features, materials, components, or manufactured devices identified on this certificate (the installation) conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the enforcement agency. . I reviewed a copy of the Certificate of Compliance (CF -111) form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF -111 that apply to the installation have been met. . I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. Company Name: (Installing Subcontractor or General Contractor or. Builder/Owner) UNIVERSAL MECHANICAL Responsible Person's Name: Responsible Person's Signature: lack Lyons Jack Lyons CSLB License: 791121 Date Signed: 11/17/2011 Position With Company (Title): Reg: 211-A0060383B-M0400001B-0000 Registration Date/Time: 2011/11/22 14:43:05 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS Duct Leakage Test — Existing Duct System .(Page 1 of 2) Site Address: Enforcement Agency: Permit Number: 178-515'Ave Ultimo, La Quinta CA 92253 (System 1) 1 City of La Qu 1 11-1242 Enter the Duct System Name or Identification/Tag: System 1 Enter the Duct System Location or Area Served: Whole House Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the dwelling. This installation certificate, is required for compliance for alterations and additions in existing dwellings to space conditioning systems and duct systems. Note: For existing dwellings, a completely new or replacement duct system can also include existing parts of the original duct system (e.g., register boots, air handler, coil, plenums, etc.) if those parts are accessible and they can be sealed. For a completely new or replacement duct system installed in an existing dwelling, use the Installation Certificate titled "Duct Leakage Test - Completely New or Replacement Duct System. " Duct Leakage Diagnostic Test - existing duct system 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 r' ❑ 3. Reduce leakage by 60% and conduct smoke and fix all leaks ❑ 4:'Fix all, accessible leaks using smoke and HERS rater verify Note: (One of Options 1, 2 or 3 must be attempted before utilizing Option 4.) Determine nominal _Fan- Flow using one of the following; three. calculation methods. ✓ R Cooling,sys-ttem method: Size of conde sn a in Tons_�S r7400 2b00�\CF,M ✓ ❑ Heating system method -:121.7 x Output Capacity in Thousands of.Btu/hr = _ CFM ..., I 1 , I I I ; ✓ f ❑ Measured systemfairflow using RA3.3 airflow test; procedures: CFM Option-1,used then:`{ /Or t,,,v N, 1 Allowed leakage = Fan -Airflow '"2000 x 0.15 = 300- CFM' -' Actual Leakage = 98 CFM ] _ Pass if Actual Leakage is less than Allowed leakage Pass Fail Option 2 used then: 2 Allowed leakage = Fan Airflow x 0.10 = _ CFM Actual Leakage to outside = _ CFM Pass if Actual leakage to outside is less than Allowed leakage Pass El 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 No Reduction > 60% ❑ Pass Ll Fail Option 4 used then: 4 All accessible leaks repaired using smoke test. HERS rater must verify (No Sampling). Pass if all accessible leaks have been repaired using smoke Pass F1 Fail' r Reg: 211-A0060383B-M2100001B-0000 Registration Date/Time: 2011/11/22 14:43:16 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 VSTALLATION CERTIFICATE CF-6R-MECH-2I-HEIR uct Leakage Test — Existing Duct System (Page 2 of : lite Address: Enforcement Agency: Permit Number: 18-515 Ave Ultimo, La Quinta CA 92253 (System 1) 1 City of La Quints 11-1242 0 Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off during duct leakage testing. CFI OA ducts that utilize controlled motorized dampers, that open only when OA ventilation.is.required to meet ASHRAE Standard 62.2, and close when OA ventilation is not required, may be configured to'the closed position during duct leakage testing. © All supply and return register boots, must- -be, sealed ;toxthe.drywall f.smokeitest,is�utiIized for-�compliance —applies to duct leakage compliance option 3,�(leakage reduction by,60%)randtopEion `4"(fix al accessible leaks) de"scribed above. • .K 0 New duct installations cannot utilize building cavities as plenums or platform returns.in lieu''of, ducts`."""' 0 Mastic "and.draw bands must -be used•in-combination; With cloth backed,rubber,adhesive;duct tape,to seal f leaks,at all new duct connections - DECLARATION STATEMENT,. • I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. • I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized representative of the person responsible for construction (responsible person). • I certify that the installed features; materials, components, or manufactured devices identified on this certificate (the installation) conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the enforcement agency. • I understand that a HERS rater will check the Installation to verify compliance, and that that if such checking identifies defects, I am required to take corrective action at my expense. I understand that Energy Commission and HERS provider representatives will also perform quality assurance checking of installations, including those approved as part of a sample group but not checked by a HERS rater, and if those Installations fail to meet the requirements of such quality assurance checking, the required corrective action and additional checking/testing of other installations in that HERS sample group will be performed at my expense. • I reviewed a copy of the Certificate of Compliance (CF -111) form approved by the enforcement agency that Identifies the specific requirements for the Installation. I certify that the requirements detailed on the CF -SR that apply to the Installation have been met.. • I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the. building permit(s) Issued for the building, and made available to the enforcement agency for all applicable Inspections. I understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. I will ensure that all Installation Certificates will come from a HERS provider data registry for multiple orientation alternatives, and beginning October 1, 2010, for all low-rise residential buildings. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) UNIVERSAL MECHANICAL Responsible Person's Name: Responsible Person's Signature: ]ack Lyons Jack Lyons CSLB License: Date Signed: ill/17/2011 Position With Company .(Title): 791121 Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control'Program (TPQCP)? ❑Yes ❑No Reg: 211-A0060383B-M2100001B-0000 Registration Date/Time: 2011/11/22 14:43:16 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE* CF-6R-MECH-2S-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of S) Site Address: Enforcement Agency: Permit Number: 78-515 Ave Ultimo, La Quinta CA 92253 - City of La Quints ' 11-1242 Note: If installation of a Charge Indicator Display (CID) is utilized as an alternative to refrigerant charge verification for compliance, a MECH-24 Certificate (instead of this MECH-25 Certificate) should be used to demonstrate compliance with the refrigerant charge verification requirement. TMAH and STMS are not required for compliance, when a CID is'utilized for compliance. As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional form(s) for any additional systems in the dwelling as applicable. Temperature Measurement Access Holes (TMAH) and Saturation Temperature Measurement Sensors (STMS) , Procedures for installing TMAH are specified in Reference Residential Appendix RA3.2. If refrigerant charge verification is required for compliance, TMAH are also required for compliance. STMS are only required for completely new or replacement space -conditioning systems that utilize prescriptive compliance method. TMAH - Access Holes in Supply and Return Plenums of Air Handler System Name or Identification/Tag -'System 1 System Location or Area Served Whole House 1 p Yes ❑ No 5/16 inch (8 mm) access hole upstream of evaporative coil in the return plenum and labeled according to Figure in Section RA3.2.2.2.2. 2 p Yes ❑ No 5/16 inch (8 mm) access hole downstream of evaporative coil in the supply plenum and labeled according to.Figure in Section RA3.2.2.2.2. Yes to,1 and 2 is a pass. t. Enter Pass or Faill ✓ Ci✓ Pass ✓ ❑ Fail L STMS`- Sensor on.the Evaporator -Coil System 'Name or Identification/Tag -V I �Xj System 1 11, -.1 , -N v*1 1 ,. " it ,, (•r I %I 3 (E] Yes pjNon 1 J ! The sensor is factory installed, or"field installed according to manufacturer's specifications, or islinstalled by methods/specifications approved by the Executive` - Director. 4 n Yes l` d� ! n No,� _ The sensor wire is terminated with a standard'mini plug suitable for connection,to a� digital thermometer. Theysensor,mini plug is accessible to,the installingttechnician ` .- and the HERS rater without changing the airflow through the condenser coil'' i 5 rl Yes n No jThe sensor measures the saturation temperature of the coil within 1.3 degrees F Yes to 3, 4; and 5 is a pass. Enter N/A if STMS are not applicable. Otherwise enter Pass or, Fail ✓ N/A ✓ ❑Pass • ✓ ❑Fail r Y , STMS - Sensor on the Condenser Coil System Name or Identification/Tag System 1 The sensor is factory installed, or field installed according to manufacturer's 6 rl Yes rl No specifications, or is installed by methods/specifications approved by the Executive Director. The sensor wire is terminated with a standard mini plug suitable for connection to a 7 ❑ Yes ❑ No digital thermometer. The sensor mini plug is accessible to the installing technician and the HERS rater without changing the airflow through the condenser coil 8 ❑ Yes ❑ No IThe sensor measures the saturation temperature of the coil within 1.3 degrees F Yes to 6, 7, and 8 is a pass. Enter N/A if STMS are not ✓ G✓ N/A ✓ E] Pass Y'❑ Fail applicable. Otherwise enter Pass or Fail n Reg: 211-A0060383B-M2500001B-0000 Registration Date/Time: 2011/11/22 14:43:27 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms August 2009 r '- INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5) Site Address: Enforcement Agency: Permit Number: 78-515 Ave Ultimo, La Quinta CA 92253 City of La Quinta 11-1242 Standard Charge Measurement Procedure (for use if outdoor air dry-bulb is above 55°F) Procedures for determining Refrigerant Charge using the Standard Charge Measurement Procedure are available In Reference Residential Appendix RA3.2. As many as 4 systems In the dwelling can be documented for compliance using this form. Attach an additional form(s) for any additional systems in the dwelling as applicable. • The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure. • The system must meet minimum airflow requirements as prerequisite for a valid refrigerant charge test. • If outdoor air dry-bulb is 55°F or below, the installer must use the Alternate Charge Measurement Procedure. Space Conditioning Systems System Name or Identification/Tag System 1 (must be re -calibrated monthly) a�c�7 Date of Th rmocouple Calibration r /` , ,r 11/1/201 �.1 System Location' or Area Served Whole House Outdoor Unit Serial # 1106251809 - �*- `""� i.•1> tj Outdoor Unit Make Goodman • Outdoor Unit Model SSX160591 Nominal Cooling Capacity Btu/hr '� 60000 Date of Verification 11/17/2011 canbratlon ot:Dlagnostic Instruments i Date `of Refrigerant Gauge Calibration 11/1/2011 (must be re -calibrated monthly) a�c�7 Date of Th rmocouple Calibration r /` , ,r 11/1/201 �.1 (must be re -calibrated monthly) Measured Temperatures'(°F) System Name or Identification/Tag System 1 Supply, (evaporator leaving) air dry-bulb - -- 50.0 - �*- `""� i.•1> tj temperature (T ) supply, db • Return (evaporator entering) air dry-bulb 70.5 temperature (Treturn, db) Return (evaporator entering) air wet -bulb 60.3 temperature (Treturn, wb) 1 Evaporator saturation temperature 38 (Tevaporator, sat) Condensor saturation temperature 79 (Tcondensor, sat) Suction line temperature (Tsuction) 51 Liquid Line Temperature (Tliquid) 69 Condenser (entering) air dry-bulb 70 temperature (Tcondenser, db) Reg: 211-A0060383B-M2500001B-0000 Registration Date/Time: 2011/11/22 14:43:27 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE . CF-6R-MECH-2S-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of S) Site Address: Enforcement Agency: Permit Number: 78-515 Ave Ultimo, La Quinta CA 92253 1 City of La Quinta 11-1242 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,. 20.50 db - Tsupply, db Target Temperature Split from Table RA3.2-3 1�.� using Treturn, wb and Treturn, db Calculate difference: Actual Temperature Split - 2.8 Target Temperature Split = Passes if difference is between -3°F and +3°F or, upon remeasurement, if between -3°F and PASS -100°F Enter Pass or Faill Note: Temperature Split Method Calculation is not necessary if actual Cooling Coil Airflow is verified using one of the airflow measurement procedures specified in Reference Residential Appendix RA3.3. If actual cooling coil airflow is measured, the value must be equal to or greater than the Calculated Minimum Airflow Requirement in the table below. s Calculated Minimum Airflow Requirement (CFM) = Nominal Cooling Capacity (ton) X 300 (cfm/ton) System Name o� Ide Aication/Tag77 System 1 Calculated Minimum Airfflo R qui �m At (CFM) Measured:Airflow,using RA3.3 procedures (CFM)// Passes if measured airflow is greater than or equal to the calculated minimum airflow requirement ''"-- c� 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: 211-A0060383B-M2500001B-0000 Registration Date/Time: 2011/11/22 14:43:27 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms August 2009 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 s System 1 Calculate: Actual Subcooling = r 10.0 i Tcondenser, sat - Tliquid Target Subcooling specified by manufacturer 12 Calculate difference:,_2 12 „ Actual Subcooling - Target Subcooling =, System passes if difference is between -3°F and +3°F , x PASS Enter Pass or, Fail Metering Device Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag System 1 Calculate: Actual Superheat =° 13.0 i Tsuction " Tevaporator, sat t . Enter allowable superheat range from manufacturer's specifications (or use range 12 between 4°F and 25°F if manufacturer's'' specification is not available)- System ipasses, if actual'superheat is -within the allowable sup'erheat ran e 9 Enter Pass or Fail CA t 40 Reg: 211-A0060383B-M2500001B-0000 Registration Date/Time: 2011/11/22 14:43:27 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms , August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-2S-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page S of S) Site Address: Enforcement Agency: Permit Number: 78-515 Ave Ultimo, La Quinta CA 92253 1 City of La Quint a 11-1242 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: Date Signed: Position With Company (Title): System meets all refrigerant charge and airflow 11/17/2011 Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): requirements. PASS Enter Pass or Fail t DECLARATION STATEMENT a . I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. . I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized representative of the person responsible for construction (responsible person). . I certify that the installed features, materials, components, or manufactured devices identified on this certificate (the installation) conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the enforcement agency. . I understand that a HERS rater will check the installation to verify compliance, and that that if such checking identifies defects, I am required to take corrective action at my expense. I understand that Energy Commission and HERS provider representatives will also perform quality assurance checking of installations, including those approved as part of a sample group but not checked by a HERS rater, and if those installations fail to meet the requirements of such quality assurance checking, the required corrective action and ' • additional checking/testing of other installations in that HERS sample group will be performed at my expense. • I reviewed a copy of the Certificate of Compliance (CF -111) form approved by the enforcement agency that Identifies the specific requirements for the installation. I certify that the requirements detailed on the CF -111 that apply to the Installation have been met. • I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder , provides to the building owner at occupancy. I will ensure that all Installation Certificates will come from a HERS provider data registry for multiple orientation alternatives, and beglnninq October 1, 2010, for all low-rise residential buildings. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) UNIVERSAL MECHANICAL Responsible Person's Name: Responsible Person's Signature: Jack Lyons Jock Lyons CSLB License: Date Signed: Position With Company (Title): 791121 11/17/2011 Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? ❑ Yes ❑ No Reg: 211-A0060383B-M2500001B-0000 Registration Date/Time: 2011/11/22 14:43:27 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms August 2009 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-21 Duct Leakage Test - Existing Duct System (Page 1 of 2) Site Address: I. Enforcement Agency:, Permit Number: %78-515 Ave Ultimo, La Quinta CA 92253 (System 1) 1 City -of La Quinta 11-1242 Enter the Duct System Name or Identification/Tag: System 1 Enter the Duct System Location or Area Served: Whole House Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the dwelling. This installation certificate is required for compliance for alterations and additions in existing dwellings to space conditioning systems and duct systems. Note: For existing dwellings, a completely new or replacement duct system can also include existing parts of the original duct system (e.g., register boots, air handler, coil, plenums, etc.) if those parts are accessible and they can be sealed. For a completely new or replacement duct system installed in an existing dwelling, use the Installation Certificate titled 'Duct Leakage Test - Completely New or Replacement Duct System. " Duct Leakage Diagnostic Test - existing duct system Select one compliance method from the following four choices. � 1. Measured leakage less than 15% of fan flow E] 2. Measured leakage to outside less than 10% of Fan Flow M 3. Reduce leakage by 60% and conduct smoke and fix all leaks I 4. Fix all accessible leaks using smoke and HERS rater verify Note: (One of Options 1, 2, or 3 must be attempted before utilizing Option 4.) Determine nominal, Fan, Flow using one, of the -following Ahree calculation methods. ✓ fJ Cooling system method: Size of condenser in Tons'5 x 400•= l 2000 CFM � r ✓ O Heating system method` 21 7'x Output Capacity in Thousands of.Btu/hr = _ CFM, ✓ " O Measured system airflow, using RA3.3 airflo _,test(procedures: CFM - —/ '*" � -/I _ Option'i,used then: (_,_ ` L - ` , "-, .. ,`- n =f- /..� �.S_ 1 Allowed leakage = Fan Flow 2000 x 0.15 = 300 CFM Actual Leakage = 8 CFM Pass if Leakage Actual is less than Allowed WPass n Fail Option 2 used then: 2 Allowed leakage = Fan Flow x 0.10 = _ CFM Actual Leakage to outside = + CFM • `! Pass if Leakage Actual is less than Allowed ❑ Pass p Fail Option 3 used then: Initial leakage prior to start of work = _ CFM Final leakage after sealing all accessible leaks using smoke test = CFM 3 Initial leakage _ - Final leakage _ = Leakage reduction _ CFM ((Leakage reduction _ / Initial leakage x 100% _ % Reduction Pass if % Reduction > 600/6 ❑ Pass p 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: 211-A0060383B-M2100001B-M21B Registration Date/Time: 2011/11/22 14:44:26 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 • L 0 Outside air (OA) ducts for'Central,Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off during duct leakage testing. CFI OA1ducts that utilize controlled motorized dampers, that open only when OA' ventilation'is.required to meet ASHRAE Standard 62.2, and close when OA ventilation is not required, may be configured to the closed position during duct leakage testing. - © All supply and?return register:boots,must be sealed•to,the drywallTif•smoke,test,is.utilized?for-=compliance — applies 6 duct leakage complianceroption 3'(leakage reduction by 60%),and'optionl4(fix all accessible leaks) described ab`ove� J` l� '• - •-�..z.,, � - 0 New duct installations cannot utilize building cavities as plenums or platform returns.in.lieu'of ducts, I j _ R Mastic and;draw. bands, must'be:used°iri combination-.with:cloth backed, rubber.adhesive,duct tape to seal leaks at all new duct connections "" ` DECLARATION STATEMENT, .. • I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. • I am the certified HERS rater who performed the verification services identified and reported on this certificate (responsible rater). • The installed feature, material, component, or manufactured device requiring HERS verification that is identified on this certificate (the. installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified on the Certificate(s) of Compliance (CF -111) approved by the local enforcement agency. • The information reported on applicable sections of the Installation Certificate(s) (CF -61k), 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. i Reg: 211-A0060383B-M2100001B-M21B• Registration Date/Time: 2011/11/22 14:44:26 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 Builder or Installer information as shown on the Installation Certificate (CF -6R) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) UNIVERSAL MECHANICAL Responsible Person's Name: CSLB License: sack Lyons - 791121 HERS Provider Data Registry Information Sample Group # (if applicable): N/A tested/verified dwelling ❑ not-tested/verified dwelling in ` a HERS sample group HERS Rater Information CalCERTS Certificate CC1-1798609135 HERS Rater Company Name: , Athens Air Responsible Rater's Name: Responsible Rater's Signature: Andrew Pulos Andrew Pulos Responsible Rater's Cert ification Number w/ this HERS Provider: CC2004503 Date Signed: 11/19/2011 ' - , i Reg: 211-A0060383B-M2100001B-M21B• Registration Date/Time: 2011/11/22 14:44:26 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 Builder or Installer information as shown on the Installation Certificate (CF -6R) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) UNIVERSAL MECHANICAL Responsible Person's Name: CSLB License: sack Lyons - 791121 HERS Provider Data Registry Information Sample Group # (if applicable): N/A tested/verified dwelling ❑ not-tested/verified dwelling in ` a HERS sample group HERS Rater Information CalCERTS Certificate CC1-1798609135 HERS Rater Company Name: , Athens Air Responsible Rater's Name: Responsible Rater's Signature: Andrew Pulos Andrew Pulos Responsible Rater's Cert CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING . CF-4R-MECH-2S Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of S) Site Address:. Enforcement Agency: _ Permit Number: X78=515 Ave Ultimo, La Quinta CA 92253 City of La Quinta 11=1242 Note: If installation of a Charge Indicator Display (CID) is utilized as an alternative to refrigerant charge verification for compliance, a MECH-24 Certificate (instead of this MECH-25 Certificate) should be used to demonstrate compliance with the refrigerant charge verification requirement. TMAH and STMS are not required for compliance, when a CID is utilized for compliance. As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional form(s) for any additional systems in the dwelling as applicable. Temperature Measurement Access Holes (TMAH) and Saturation Temperature Measurement Sensors (STMS) Procedures for installing TMAH are specified in Reference Residential Appendix RA3.2. If refrigerant charge verification is required for compliance, TMAH are also required for compliance. STMS are only required for completely new or replacement space -conditioning systems that utilize prescriptive compliance method. TMAH —Access Holes in Supply and Return Plenums of Air Handler System Name or Identification/Tag System.1 System Location or Area Served Whole House 1 p Yes ❑ No - 5/16 inch (8 mm) access hole upstream of evaporative coil in the return plenum and labeled according to Figure in Section RA3.2.2.2.2. 2 p Yes ❑ No 3 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. - Enter Pass or Faill V 0 Pass V ❑ Fail STMS - Sensor_-on,the Evaporator Coil _ ..moi a ------ -- -•-.- -- n System Name or Identification/Tag`') f ,Ir/ System 1 1 -1 1 t gT I( )j f ( V (O'Yes ❑ No' �� ; The sensor is factory installed, orfield installed according to manufacturers3 specifications, or is"installed by methods/specifications approved by the Executive Director. f k` - •!�-'s 4D,Yes+�f ❑ No t1 p No The sensor wire is terminated with a standard mini plug suitable for connection to a digital'thermometer. The'sensor mini plug is accessible to the.insEalling teclinician'V-1 and the HERS rater without changing the airflow through the condenser coil 5 ❑ Yes.--•,- ❑ No y 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 V Fj N/A T V ❑ Pass V ❑ Fail STMS - Sensor on the Condenser Coil System Name or Identification/Tag System 1 The sensor is factory installed, or field installed according to manufacturer's 6 ❑ Yes ❑ No specifications, or is installed by methods/specifications approved by the Executive Director. The sensor wire is terminated with a standard mini plug suitable for connection to a 7 ❑ Yes ❑ No digital thermometer. The sensor mini plug is accessible to the installing technician and the HERS rater without changing the airflow through the condenser coil 8 ❑:Yes ❑ No 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 R N/A V E] Pass V ❑Fail applicable. Otherwise enter Pass or Fail Reg: 211-A0060383B-M2500001B-M25B Registration Date/Time: 2011/11/22 14:44:42 HERS Provider: Ca10ERTS,,Inc. 2008 Residential Compliance Forms March 2010 • CERTIFICATE OF FIELD VERIFICATION 8t DIAGNOSTIC TESTING CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5) Site Address: Enforcement Agency: Permit Number: 78-515 Ave Ultimo, La Quinta CA 92253 1 City of La Quinta 11-1242 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 RA3.1. As many as 4 systems In the dwelling can be documented for compliance using this form. Attach an additional form(s) for any additional systems In the dwelling as applicable. • The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure. • The system must meet minimum airflow requirements as prerequisite for a valid refrigerant charge test. • If outdoor air dry-bulb is 55°F or below, the installer must use the Alternate Charge Measurement Procedure. Space Conditioning Svstems System Name or Identification/Tag System 1 (must be re -calibrated monthly) .. Date of h6imo ouple,Calibration j �, r J1, /1/201 System Location or Area Served Whole House . � Outdoor Unit Serial # 1106251809 Outdoor Unit Make Goodman ' Outdoor Unit Model SSX160591 Nominal Cooling Capacity Btu/hr' , 60000 _ Date of Verification i. 11/19/2011 calibration of Diagnostic Instruments Date of Refrigerant Gauge Calibration 11/1/2011 (must be re -calibrated monthly) .. Date of h6imo ouple,Calibration j �, r J1, /1/201 t 1t fir: c, (must be r; calibrated monthly) f . � Measured Temperatures'(_'F) [r I i . System Name or Identification/Tag • Sys � ik . t +-.vj 91 .4 tem 1 � . � f !` E '� temperature (Tsupply, db) Return (evaporator entering) air dry-bulb 70.5 i . System Name or Identification/Tag • Sys � ik . t +-.vj 91 .4 .r Supply `(evaporator leaving),air dry-bulb' 51.0 temperature (Tsupply, db) Return (evaporator entering) air dry-bulb 70.5 temperature (T d ) return, b _ Return (evaporator entering) air wet -bulb 61.2 temperature T i p (return, wb) Evaporator saturation temperature 35- (Tevaporator, sat) Condensor saturation temperature 78 (Tcondensor, sat) Suction line temperature (Tsuction) 48 Liquid Line Temperature (Tliquid) 66 Condenser (entering) air dry-bulb 70 temperature (Tcondenser, db) Reg: 211-A0060383B-M2500001B-M25B Registration Date/Time: 2011/11/22 14:44:42 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 FALLATION CERTIFICATE CF-4R-MEC1 -igerant Charge Verification - Standard Measurement Procedure (Page 3 c Address: Enforcement Agency: Permit Number: 515 Ave Ultimo, La Quinta CA 92253 City of La Quinta 11-1242 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 = Tretum, 19.50 db - Tsupply, db Target Temperature Split from Table RA3.2-3 17.2 using Treturn, wb and Treturn, db Calculate difference: Actual Temperature Split - 2.3 Target Temperature Split = Passes if difference is between -4°F and +4°F or, upon remeasurement, if between -4°F and PASS -100°F Enter Pass or Fail Note: Temperature Split Method Calculation is not necessary if actual Cooling Coil Airflow is verified using one of the airflow measurement procedures specified in Reference Residential Appendix RA3:3. If actual cooling coil airflow is measured, the value must be equal to or greater than the Calculated Minimum Airflow Requirement in the table below. Calculated Minimum Airflow Requirement (CFM) = Nominal Cooling Capacity (ton) X 300 (dm/ton) e o Identification/Tag System Name Calculated Minimum Airflow Requirement (CFM) k -&J* r n■ At i-,• t Measured, Airflow using RA3.3 procedures (CFM) Passes if measured airflow is greater than or equal to the calculated minimum airflow, requirement. Enter Pass or Fail Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for fixed orifice metering device systems System Name or. Identification/Tag 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 = m passes if difference Is between -6°F and E-tF Enter Pass or Fail Reg: 211-A0060383B-M2500001B-M25B Registration Date/Time: 2011/11/22 14:44:42 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 0' INSTALLATION CERTIFICATE CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5) Site Address: Enforcement Agency: Permit Number: 78-515 Ave Ultimo, La Quinta CA 92253 City of La Quinta 11-1242 Subcooling Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag System 1 r Calculate: Actual Subcooling = 12.0 Tcondenser, sat - Tliquid 13.0 Target Subcooling specified by manufacturer 12 Calculate difference: 0 _ Actual Subcooling - Target Subcooling = 12 System passes if difference is between . -4°F and +4°F - I PASS _ _ _ ' Enter Pass or Fail PASS ri' r " Metering Device Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag System 1 Calculate: Actual Superheat = ' 13.0 Tsuction - Tevaporator, sat i Enter allowable superheat range from manufacturer's specifications (or use range 12 between 3°F and 26°F if manufactu'rer's specification is not available) _, .,-. • _ _ _ System'passes if actual superheat is withicrthe "" allowable superheat range / j PASS ri' r " . EnterPa s or Fail f : � 1 f •.-1'f "" . p, t t 4 Xi"R ' t Reg: 211-A0060383B-M2500001B-M25B Registration Date/Time: 2011/11/22 14:44:42 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 • •r 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. INSTALLATION CERTIFICATE CF-411-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of S) Site Address: Enforcement Agency: Permit Number: 78-515 Ave Ultimo, La Quinta CA 92253 1 City of La Quinta 11-1242 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 1791121 HERS Provider Data Registry Information Sample Group # (if applicable): N/A R tested/verified dwelling System meets all refrigerant charge and airflow , a.HERS sample group HERS Rater Information CalCERTS Certificate # CC1-1798609135 HERS Rater Company Name: requirements. PASS Responsible Rater's Signature: Andrew Pulos Andrew Pulos. Enter Pass or Fail Date Signed: 11/19/2011, CC2004503- r F 4 t " C� DECLARATION STATEMENT!,' • I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. • I am the certified HERS rater who performed the verification services identified and reported on this certificate (responsible rater). • The installed feature, material, component, or manufactured device requiring HERS verification that is identified on this certificate (the installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified on the Certificate(s) of Compliance (CF -111) approved by the local enforcement agency. • The information reported on applicable sections of the Installation Certificate(s) (CF -611), signed and submitted by the person(s) responsible for the Installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -1R) approved by the enforcement aoencv. Builder or Installer information as shown on the Installation Certificate (CF -6R) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) UNIVERSAL MECHANICAL Responsible Person's Name: CSLB License: Jack Lyons 1791121 HERS Provider Data Registry Information Sample Group # (if applicable): N/A R tested/verified dwelling ❑not-tested/verified dwelling in , a.HERS sample group HERS Rater Information CalCERTS Certificate # CC1-1798609135 HERS Rater Company Name: Athens Air Responsible Rater's Name: Responsible Rater's Signature: Andrew Pulos Andrew Pulos. Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 11/19/2011, CC2004503- Reg: 211-A0060383B-M2500001B-M25B -Registration Date/Time: 2011/11/22 14:44:42 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forme March 2010 Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-IR-ALT-HVAC .Climate Zones 10 - 15 Site Address: Enforcement Agency: Date: Permit #: 78-515 Ave Ultimo La Quinta, CA 92253 City of La Quinta Nov 22, 2011 Duct insulation Conditioned Floor Equipment Typel List Minimum Efficiency2 requirement Area Thermostat Package Unit ❑ Furnace ❑ Indoor Coil ❑ AFUE Gqj SEER 13.0 ❑ COP ❑ HSPF p R 6 (CZ 10-13) Served by system 0 Setback If not already present, must be Condensing Unit El EER E] Resistance C] R 8 (CZ 14-15) z50o installed) ❑ Other 1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF-IR-ALT-HVAC for each system. 2. Minimum Equipment Efficiencies: 13 SEER, 78% AFUE, 7.7HSPF for typical residential systems. HERS VERIFICATION SUMMARY Listed below are FOUR HVAC alteration Options. The Installer decides what work is being done and picks one of the appropriate Options. Each Option lists the HERS measures that must be conducted. A copy of the forms shall be left on site for final inspection and a copy given to the homeowner. At final, the inspector verifies that the work listed on this form was in fact the work completed by the installer. The inspector also verifies that each appropriate CF-611 and registered CF-411 forms (no hand filled CF-4Rs allowed) are filled out and signed.Beginning October 1, 2010, a registered copy of the CIF-IR and CF-6R shall also be on site for final inspection. G� 1. HVAC Changeout Required Forms: • All HVAC Equipment CF-6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS replaced CF-411 forms: MECH-21 and (for split systems) MECH-25 Condenser Coil and /or_ CF-6R forms: MECH-04 1MECH-21-HERS.and: (for split systems)'MECH=25=HERS • Indoor_Coil and/or - CF-4R forms: MECH-21 and (for split systems) MECH-25! ^, • Furnace -- - For Split Systems: Duct leakage <•15 percent; RC, CCA <_ 300 CFM/ton (Minimum Air Flow Requirement), TMAH Exempted from duct leakage testing;if: ❑ 1. Duct system was documented to have been previously sealed and confirmed through HERS verification, or ❑ 2. Duct systems with less than 40 linear feet in unconditioned space, or ❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos 1-14. The system,will not be Ducted (ie••Ductless Mini-Split System),(Also,Exempt,from;Refrigerant Charge) . ❑ 2. New HVAC System Required'Forms:' .• f rF:`? . " r s )' +x o'Ns` 41 . Cut in;or Changeout with' new ducts: (all new CF-6R forms?MECH-04, MECH 20*HERS and (fog split systems) MECH 22 HERS, and . F ,; ' ducting and all newjolv MECH .251HERS'^ 1� r r1,_'; 4;;) CF-4R forms: MECH 20, and (for split systems) MECH 22, and MECH-25 r equipment) - For Split Systems: Duct leakage <t6 CCA: >_ 350 CFM/ton;`FWD,•TMAH, SIMS, and either HSPP or PSPP. For Packaged Units: Duct leakage'< 6 percent. 0- 3. New Ducts with/or without, .. Required Forms: Replacement . Includes replacing or installing all new ducting and/or outdoor condensing unit CF-611 forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS and/or indoor coil and/or fumace. No or some CF-4R forms: MECH-20 and (for, split systems) MECH-25 equipment changed. For Split Systems: Duct leakage < 6 percent; RC, CCA .>_ 300 CFM/ton, TMAH For Packaged Units: Duct leakage < 6 percent G 4. New Ducting over 40 feet Required Forms: . Includes adding or replacing more than 40 CF-6R forms: MECH-04, MECH-2I-HERS linear feet of duct in unconditioned space. CF-4R forms: MECH-21 For split system or packaged units: Duct leakage < 15 percent ❑ EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos. Contractor (Documentation Author's /Responsible Designer's Declaration Statement) • I certify that this Certificate of Compliance documentation Is accurate and complete. • I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of Compliance. • I certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24, Parts 1 and 6 of the California Code of Regulations. • The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with the permit application. Name: I ISignature: Company: UNIVERSAL MECHANICAL Date: Nov 19, 2011 Address: 74698 CANDLEWOOD STRET License: 791121 City/State/Zip: PALM DESERT / CA / 92260 Phone: (760) 851-9679 t.,, Reg: 211-A0060384C-00000000-0000 Registration Date/Time: 2011/11/19 23:28:30 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms July 2010 , INSTALLATION CERTIFICATE CF-6R-MECH-0 Space Conditioning Systems, Ducts and Fans (Page 1 of 2) Site Address:. _ _ _ _ Enforcement Agency: Permit Number: L78 -515 -Ave Ultimo, La Quinta CA 92253•(Sysi 2) "City of La Quin11-1242 - 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.) Dud R -value Heating Load - (kBtu/hr) Heating Capacity (kBtu/hr) 'Equip (SEER Location Type ( and EER) _ (attic, (package ARI # of 1, 3 crawl- Cooling Cooling heat CEC Certified Mfr. Name Reference , Identical (>=CF -1R space, Duct Load Capacity pump) ^'+••-.and Model Number, Number2 Systems value)4 etc.) R -value (kBtu/hr) (kBtu/hr) I - --. Goodman 16 SEER. - - - Loonno &au/pmenr s > 1. If project is new construction, see Footnotes to Standards Table 151-B and Table 151-C for duct ceiling alternative compliance. 2. ARI Reference Number can be found by entering the equipment model number at http://www.aridirectory. org/ari/ac: php # 3. Listed efficiency on this page must be greater than or equal ( ? ) to the value shown on the CF -1 R_ form. 4. When CF -IR is reference it is also applicable to the CF -IR, 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. 0 §150(i): 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. • E Reg: 211-A0060384C-M0400001B-0000 `Registration Date/Time: 2011/11/22 14:46:44 HERS Provider: CalCERTS,. Inc. 2008 Residential Compliance Forme August 2009 Y Efficiency Duct 'Equip (SEER Location Type ( and EER) _ (attic, (package ARI # of 1, 3 crawl- Cooling Cooling heat CEC Certified Mfr. Name Reference , Identical (>=CF -1R space, Duct Load Capacity pump) ^'+••-.and Model Number, Number2 Systems value)4 etc.) R -value (kBtu/hr) (kBtu/hr) Split_,1 - --. Goodman 16 SEER. - - if A/C -- SSX160361 -- _ - 1 _ 13. EER, - Attic_ 24- -_-_ -- �.3Tons-- .` • � :_ '�"'� may, ;.,. ,�"'�''';f ,r 4 U "JI, , k f Y 1JAe s > 1. If project is new construction, see Footnotes to Standards Table 151-B and Table 151-C for duct ceiling alternative compliance. 2. ARI Reference Number can be found by entering the equipment model number at http://www.aridirectory. org/ari/ac: php # 3. Listed efficiency on this page must be greater than or equal ( ? ) to the value shown on the CF -1 R_ form. 4. When CF -IR is reference it is also applicable to the CF -IR, 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. 0 §150(i): 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. • E Reg: 211-A0060384C-M0400001B-0000 `Registration Date/Time: 2011/11/22 14:46:44 HERS Provider: CalCERTS,. Inc. 2008 Residential Compliance Forme August 2009 INSTALLATION CERTIFICATE CF-6111-MECH-0 Space Conditioning Systems, Ducts and Fans (Page 2 of 2) Site Address: Enforcement Agency: Permit Number: 78-515 Ave•Ultimo, La Quinta CA 92253 (System 2) 1 City of La Quinta 11-1242 Ducts and Fans §150(m): Duct and Fans Ei 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 2 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. Gi 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. F17. Exhaust fan systems have back draft or automatic dampers. Ri 8. Gravity ventilating systems serving conditioned space have either automatic or readily accessible, manually operated dampers. R Protection of Insulation. 'Insulation shall be protected from damage, including that due to sunlight, moisture, equipment maintenance, and wind. Cellular foam insulation shall be protected as above or painted with a coating that is water retardant and provides shielding from solar radiation that can cause ,degradation-of.the material. 0 10. Flexible ducts cannot have porous inner cores. 724� 7�� L _ DECLARATION STATEMENT t . I`certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. • I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized representative of the person responsible for construction (responsible person). . I certify that the installed features, materials, components, or manufactured devices identified on this certificate (the installation) conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the enforcement agency. . I reviewed a copy of the Certificate of Compliance (CF -111) form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF -111 that apply to the installation have been met. • I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate Is required to be included with the documentation the builder provides to the building owner at occupancy. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) UNIVERSAL MECHANICAL Responsible Person's Name: Responsible Person's Signature: Jack Lyons Jack Lyons CSLB License: 791121 Date Signed: 11/17/2011 Position With Company (Title): Reg: 211-A0060384C-M0400001B-0000 Registration Date/Time: 2011/11/22 14:46:44 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS Duct Leakage Test — Existing Duct System (Page 1 of 2) Site Address: _. Enforcement Agency: Permit Number: T78=515 Ave Ultimo, La Quinta CA 92253 (System 2) City of La Quinta 1 11-1242 Enter the Duct System Name or Identification/Tag: System 2 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. " Dud Leakage Diagnostic Test - existing duct system Select one compliance method from the following four choices. © 1. Measured leakage less than 15% of fan flow 2. Measured leakage to outside less than 10% of Fan Flow M 3. Reduce leakage by 60% and conduct smoke and fix all leaks 4. Fix all accessible leaks using smoke and HERS rater verify Note: (One of Options 1, 2 or 3 must be attempted before utilizing Option 4.) Determine nominal -Fan Flow using one of the following three, calculation, methods. ✓ © Cool ing,syste method: Size of ondenser in Tons 3X400 = 12 CFM ✓ ❑ Heating system method:421:7 x Output Capacity in Thousands of.Bt /hr = _ CFM40 —V✓ 1 } t - � El Measured systemfairflow using3.3 airflow test,;procedures: CFM - " Option,1 used then: 'r �. �;. +�f-ter f ' a 1. y.e�, a ,,`• �� ' 1 Allowed leakage = Fan Airflow 1200 x 0.15'= 180 CFM Actual Leakage 98 CFM.3 —;, Pass if Actual Leakage is less than Allowed leakage Pass n Fail K Option 2 used then: i 2 Allowed leakage = Fan Airflow x 0.10 = _ CFM Actual Leakage to outside = •' CFM l Pass if Actual leakage to outside is less than Allowed leakage Pass Fail Option 3 used then: Initial leakage prior to start of work = _ CFM Final leakage after sealing all accessible leaks using smoke test = _ CFM 3 Initial leakage _ - Final leakage _ = Leakage reduction_ CFM ((Leakage reduction _/ Initial leakage x 100% _ % Reduction Pass if % Reduction > 600/o Pass n Fail Option 4 used then: 4 All accessible leaks repaired using smoke test. HERS rater must verify (No Sampling). Pass if all accessible leaks have been repaired using smoke Pass Fail Reg: 211-A0060384C-M2100001B-0000 Registration Date/Time: 2011/11/22 14:46:55 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS Duct Leakage Test - Existing Duct System (Page 2 of 2) Site Address: Enforcement Agency: Permit Number: 78-515 Ave Ultimo, La Quinta CA 92253 (System 2) 1 City of La Quinta 11-1242 Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off during duct leakage testing. CFI OA ducts that utilize controlled motorized dampers, that open only when OA ventilation is required to meet ASHRAE Standard 62.2, and close when OA ventilation is not required, may be configured to the closed position during duct leakage testing. All supply andoreturn register boots must•be.sealed to -the drywall -if.smoke.test.is;utilized:for compliance - applies t�o"duct leakag ,rte 1 - f _? J �. y�; leaks) described above. f iL, New duct installations ca of utilize building cavitie s plenums or platform returns ilieu of ducts. Mastic and draw bands must be used in _combination with _cloth _backed rubber adhesive duct tape to seal. leaks at all new duct connection's DECLARATION STATEMENT • I certify under penalty of perjury, under,the laws of the State of California, the information provided on this form is true and correct. . I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized representative of the person responsible for construction (responsible person). • I certify that the installed features, materials, components, or manufactured devices identified on this certificate (the installation) conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the enforcement agency. • I understand that a HERS rater will check the installation to verify compliance, and that that if such checking identifies defects, I am required to take corrective action at my expense. I understand that Energy Commission and HERS provider representatives will also perform quality assurance checking of installations, including those approved as part of a sample group but not checked by a HERS rater, and if those Installations fall to meet the requirements of such quality assurance checking, the required corrective action and additional checking/testing of other installations in that HERS sample group will be performed at my expense. • I reviewed a copy of the Certificate of Compliance (CF -111) form approved by the enforcement agency that Identifies the specific requirements for the installation. I certify that the requirements detailed on the CF -111 that apply to the installation have been met. . I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable Inspections. I understand that a signed copy of this Installation Certificate is required to be Included with the documentation the builder provides to the building owner at occupancy. I will ensure that all Installation Certificates will come from a HERS provider data registry for multiple orientation alternatives, and beginning October 1, 2010, for all low-rise residential buildings. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) UNIVERSAL MECHANICAL Responsible Person's Name: Responsible Person's Signature: Jack Lyons Jack Lyons CSLB License: 791121 Date Signed: 111/17/2011 Position With Company (Title): Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? ❑ Yes ❑ No Reg: 211-A0060384C-M2100001B-0000 Registration Date/Time: 2011/11/22 14:46:55 ITERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forme March 2010 i �` ' � � r INSTALLATION CERTIFICATE* CF-611-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 5) Site Address: I Enforcement Agency:Permit Number: *78-515 Ave Ultimo, La Quinta.CA.92253 S yS0,2,1 City of La Quinta 11-1242 Note: If installation of a Charge Indicator Display (CID) is utilized as an alternative to refrigerant charge verification for compliance, a MECH-24 Certificate (instead of this MECH-25 Certificate) should be used to demonstrate compliance with the refrigerant charge verification requirement. TMAH and STMS are not required for compliance, when a CID is utilized for compliance. As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional form(s) for any additional systems In the dwelling as applicable. Temperature Measurement Access Holes (TMAH) and Saturation Temperature Measurement Sensors (SIMS) Procedures for installing TMAH are specified in Reference Residential Appendix RA3.2. If refrigerant charge verification is required for compliance, TMAH are also required for compliance. STMS are only required for completely new or replacement space -conditioning systems that utilize prescriptive compliance method. TMAH - Access Holes in Supply and Return Plenums of Air Handler System Name or Identification/Tag System 2 System Location or Area Served Whole House 1 Yes No 5/16 inch (8 mm) access hole upstream of evaporative coil in the return plenum and labeled according to Figure in Section RA3.2.2.2.2. 2 Yes No 5/16 inch (8 mm) access hole downstream of evaporative coil in the supply plenum and labeled according to Figure in Section RA3.2.2.2.2. Yes to.1 and 2 is a pass. Enter Pass or Faill Pass IFail STMS`- Sensor on,the Evaporator. Coil System'Name or Identification/Tag15 r te' System 2 ?1' } j 1Y 3Y es fNo The sensor is factory installed, or,,field installed according to manufacturer's specifications, or i 4 r� Yeses! I � f �s �- L.No '' iThe sensor wire is terminated witli a standard mini plug suitable fog connection to a�. digital thermometer. The sensor miniplug isaccessible to`the installingtechn`iciari and the HERS rater without changing the airflow through the condenser coil' 5Yes No The sensor measures the saturation temperature of the coil within 1.3 degrees F Yes to 3, 4, and 5 is a pass. Enter N/A if STMS are not applicable.,Otherwise enter Pass or�Fail N/A Pass Fail r _ STMS - Sensor on the Condenser, -Coil ' System Name or Identification/Tag I System 2 The sensor is factory installed, or field installed according to manufacturer's 6 n Yes n No specifications, or is installed by methods/specifications approved by the Executive Director. The sensor wire is terminated with a standard mini plug suitable for connection to a 7 ❑ Yes ❑ No digital thermometer. The sensor mini plug is accessible to the installing technician and the HERS rater without changing the airflow through the condenser coil 8 ❑ Yes I No IThe sensor measures the saturation temperature of the coil within 1.3 degrees F Yes to 6, 7, and 8 is a pass. Enter N/A if STMS are not T V .r N/A V ❑ Pass V ElFail applicable. Otherwise enter Pass or Fail Reg: 211-A0060384C-M2500001B-0000 .Registration Date/Time: 2011/11/22 14:47:09 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms August 2009 STALLATION CERTIFICATE CF-611-MECH-25-HE frigerant Charge Verification - Standard Measurement Procedure (Page 2 of to Address: Enforcement Agency: Permit Number: 1-515 Ave Ultimo, La Quinta CA 92253 1 City of La Qu 1 11-1242 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. SDace Conditionina Svstems System Name or Identification/Tag System 2 . (must be re -calibrated monthly) Date of Thermocouple Calibration, 11/1/201 ! System Location or Area Served Whole House Outdoor Unit Serial # 1005752566 s - Outdoor Unit Make Goodman Outdoor Unit Model SSX160361 Nominal Cooling, Capacity Btu/hr'"I 36000 Date of Verification 11/17/2011 cauoration Or.maanostic instruments Date of Refrigerant Gauge Calibration 11/1/2011 (must be re -calibrated monthly) Date of Thermocouple Calibration, 11/1/201 ! must be re -calibrated monthly) Aj I -A measurea Temoeratures,(!F) i ■ -.17 ■ -'r- I System Name or Identification/Tag System 2 ! Fw a ," Wr i'w .-41" Aj I -A Supply (evaporator leaving) air dry=bulb' - 51.3 s - temperature (Tsupply, db) ' Return (evaporator entering) air dry-bulb 70.0 temperature (Treturn,'db) .r Return (evaporator entering) air wet -bulb 60.0 temperature (Treturn, wb) \. Evaporator saturation temperature 34 (Tevaporator, sat) Condensor saturation temperature 78 (Tcondensor, sat) Suction line temperature (Tsuction) 46 Liquid Line Temperature (Tliquid) 65 Condenser (entering) air dry-bulb 70 temperature (Tcondenser, db) Reg: 211-A0060384C-M2500001B-0000 Registration Date/Time: 2011/11/22 14:47:09 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms August 2009 i' INSTALLATION CERTIFICATE CF-611-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5) Site Address: Enforcement Agency: Permit Number: 78-515 Ave Ultimo, La Quinta CA 92253 1 City of La Quinta 11-1242 Minimum Airflow Requirement Temperature Split Method Calculations for determining Minimum Airflow Requirement for Refrigerant Charge Verification. The temperature split method is specified in Reference Residential Appendix RA3.2. System Name or Identification/Tag System 2 ` Calculate: Actual Temperature Split = Treturn, 18.70 db - Tsupply, db Target Temperature Split from Table RA3.2-3 17.7 using Treturn, wb and Treturn, db Calculate difference: Actual Temperature Split - 1 ' 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 Fai Note: Temperature Split Method Calculation is not necessary if actual Cooling Coil Airflow is verified using one of the airflow measurement procedures specified in Reference Residential Appendix RA3.3. If actual cooling coil airflow is measured, the value must be equal to or greater than the Calculated Minimum Airflow Requirement in the table below. Calculated Minimum Airflow Requirement (CFM) = Nominal Cooling Capacity (ton) X 300 (dm/ton) t? gd System Name or Identification/Ta S stem 2 S em Calculated Minimum Airflo R quirement (CFM) {f � Measured.Airflow.usin RA3.3 procedures (CFM )/,, Passes if measured airflow is greater than or equal to the calculated minimum airflow requirement:"" Enter Pass or Fail Superheat Charge Method: Calculations for Refrigerant Charge Verification. This procedure is required to be used for fixed orifice metering device systems System Name or Identification/Tag System 2 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 Fall Reg: 211-A0060384C-M2500001B-0000 Registration Date/Time: 2011/11/22 14:47:09 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms August 2009 5TALLATION CERTIFICATE CF-6R-MECH-25-HE Prigerant Charge Verification --Standard Measurement Procedure (Page 4 o; e Address: Enforcement Agency: Permit Number: -515 Ave Ultimo, La Quinta CA 92253 City of La Quinta 11-1242 Subcooling Charge Method Calculations for Refrigerant for thermostatic expansion valve (TXV) and electronic exp System Name or Identification/Tag System 2 S, Calculate: Actual Subcooling = • 13.0 Tcondenser, sat - Tliquid Target Subcooling specified by manufacturer -• 12 Calculate difference:- Actual Subcooling -.Target Subcooling 1 System passes if difference is between -3°F and +3°F PASS -Enter Pass or Fail - �°-•-`� �'jo'.4klallowable PASS y� " Charge Verification. This procedure is required to be used , expansion valve (EXV) systems. c Metering Device Calculations for Refrigerant Charge Verification. This procedure Is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag. System 2 S, Calculate: Actual Superheat = _ Charge Verification. This procedure is required to be used , expansion valve (EXV) systems. c Metering Device Calculations for Refrigerant Charge Verification. This procedure Is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag. System 2 ,i w. Calculate: Actual Superheat = _ 12.0 Tsuction - Tevaporator, sat ' r Enter -allowable superheat range from , manufacturer's specifications (or use range 12 between 4°F and 25°F if manufacturer's specification is not available) J •• System pa ,ses Vactual'superheat isrmithin.the` superheat range �h� - �°-•-`� �'jo'.4klallowable PASS y� " Enter Pass or Fail` - P u P ,i w. • + . t- Reg: 211-A0060384C-M25000018-0000 Registration Date/Time: 2011/11/22 14:47:09 HERS Provider: Ca10ERTS,'Inc. 2008 Residential Compliance Forms, August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5) Site Address: Enforcement Agency: Permit Number: 78-515 Ave Ultimo, La Quinta CA 92253 City of La Quinta 11-1242 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 Identifiication/Tag System 2 CSLB License: 791121 Date Signed: 11/17/2011 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 _ I i DECLARATION STATEMENT t • I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. • I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized representative of the person responsible for construction (responsible person). • I certify that the installed features; materials, components, or manufactured devices identified on this certificate (the installation) conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the enforcement agency. • I understand that a HERS rater will check the installation to verify compliance, and that that if such checking identifies defects, I am required to take corrective action at my expense. I understand that Energy Commission and HERS provider representatives will also perform quality assurance checking of installations, Including those approved as part of a sample group but not checked by a HERS rater, and if those installations fail to meet the requirements of such quality assurance checking, the required corrective action and additional checking/testing of other installations in that HERS sample group will be performed at my expense. • I reviewed a copy of the Certificate of Compliance (CF -111) form approved by the enforcement agency that Identifies the specific requirements for the Installation. I certify that the requirements detailed on the CF -111 that apply to the Installation have been met. • I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable Inspections. I understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. I will ensure that all Installation Certificates will come from a HERS provider data registry for multiple orientation alternatives, and beginning October 1, 2010, for all low-rise residential buildings. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) UNIVERSAL MECHANICAL Responsible Person's Name: Responsible Person's Signature: )ack Lyons Jock Lyons CSLB License: 791121 Date Signed: 11/17/2011 Position With Company (Title): Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? ❑ Yes . ❑ No Reg: 211-A0060384C-M2500001B-0000 Registration Date/Time: 2011/11/22 14:47:09 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms August 2009 f, 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: ,78=51S Ave Ultimo, La Quinta CA 92253 (System 2) Cityof La Qu 1 11-1242 Enter the Duct System Name or Identification/Tag:•System 2 Enter the Duct System Location or Area Served: Whole House Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the dwelling. This installation certificate is required for compliance for alterations and additions in existing dwellings to space conditioning systems and duct systems. Note: For existing dwellings, a completely new or replacement duct system can also include existing parts of the original duct system (e.g., register boots, air handler, coil, plenums, etc.) if those parts are accessible and they can be sealed. For a completely new or replacement duct system installed in an existing dwelling, use the Installation Certificate titled "Duct Leakage Test - Completely New or Replacement Duct System." Duct Leakage Diagnostic Test - existing duct system ' Select one compliance method from the following four choices. 1. Measured leakage less than 15% of fan flow ti ❑ 2. Measured leakage to outside less than 10% of Fan Flow M 3. Reduce leakage by 60% and conduct smoke and fix all leaks 4. Fix all accessible leaks using smoke and HERS rater verify l , Note: (One of Options 1, 2, or 3 must be attempted before utilizing Option 4.) Determine nominakFan Flow using one of the, following Ahree calculation methods., _ ✓ Lj Coolijng system method: Size of cont nser in Tons )3 1 x 400 =-I 1200 NCFM f ✓ ri ❑Heating system method.: 21.7 x _Output Capacity in -Thousands of•Btu/hr = _CFM t using ✓ ❑Measured system'rairflow RA3.3 airflow,test{procedures: _CFM Option'l.used then: L_ ; f. ,'�. �` / �_ •_ y,G .. c^, gest?. 1 Allowed leakage = Fan Flow 1200 x 0.15 = 180 CFM Actual Leakage = 98 CFM - £J _ ---- —'V Pass if Leakage Actual is less than Allowed Pass Fail Option 2 used then: 2 Allowed leakage = Fan Flow = x 0.10 = _ CFM , Actual Leakage to outside = CFM Pass if Leakage Actual is less than Allowed Pass Fail Option 3 used then: Initial leakage prior to start of work = _ CFM Final leakage after sealing all accessible leaks using smoke test = CFM 3 Initial leakage _ - Final leakage _ =,Leakage reduction _ CFM , ((Leakage reduction _ / Initial leakage 1 x 100% _ % Reduction Pass if "/o Reduction > 600/a 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: 211-A0060384C-M2100001B-M21B 'Registration Date/Time: 2011/11/22 14:48:04 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-21 Duct Leakage Test - Existing Duct System (Page 2 of 2) Site Address: Enforcement Agency: Permit Number: '78=515 Ave Ultimo, La Quinta CA 92253 (System 2) City of La Quinta 11-1242 0 Outside air (OA) ducts for Central.Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off during duct leakage testing. CFI OA ducts that utilize controlled motorized dampers, that open only when OA ventilation• is, required to meet ASHRAE Standard 62.2, and close when OA ventilation is not required, may be configured to the closed position during duct leakage testing. 0 All supply.andrreturn reg ister'boots-must-be,sea led,to the. drywail,if,smoke'ktest-is=utilized!for compliance - applies}to'dtict leakage compl6rice4ption 3'(leakage `reduction by 60%)'androption[4 (fik all kcessible - leaks) d6 scribed abov� � ©New duct installations cannot utilize building cavltles as plenums or platform returns.in lieu of ducts % MaStic'and'draw bands_•must,be used in comtiination:wlth:cloth backed rubber adhesive duct�tape to eal,' leaks at all new duct connections x DECLARATION STATEMENT; . I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. . I am the certified HERS rater who performed the verification services identified and reported on this certificate (responsible rater). . The installed feature, material, component, ror 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 -1R) 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) UNIVERSAL MECHANICAL ' Responsible Person's Name: CSLB License:. ,lack Lyons s 1791121 HERS Provider Data Registry Information Sample Group #.(if applicable): N/A tested/verified dwelling ❑not-tested/verified dwelling in • a HERS sample group HERS Rater Information CalCERTS Certificate # CCl-1798609136 HERS Rater Company Name: Athens Air Responsible Rater's Name: , . Responsible Rater's Signature: '• Andrew Pulos Andrew Pulos Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 11/19/2011 CC2004503 Reg: 211-A0060384C-M2100001B-M21B. Registration Date/Time: 2011/11/22 14:48:04 HERS Provider: Ca10ERTS_ Inc. 2008 Residential Compliance Forms March 2010 r CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 5) Site Address: Enforcement Agency: Permit Number: 78515 Ave Ultimo, La.Quinta.CA.92253 City of La Quinta 11-1242 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 change verification is required for compliance, TMAH are also required for compliance. STMS are only required for completely new or replacement space -conditioning systems that utilize prescriptive compliance method. TMAH - Access Holes in Supply and Return Plenums of Air Handler System Name or Identification/Tag -'-System 2 System Location or Area Served Whole House 1 p Yes ❑ No 5/16 inch (8 mm) access hole upstream of evaporative coil in the return plenum and labeled according to Figure in Section RA3.2.2.2.2. 2 p Yes ❑ No 5/16 inch (8 mm) access hole downstream of evaporative coil -in the supply plenum and labeled according to Figure in Section RA3.2.2.2.2. Yes to Land 2 is a pass. Enter Pass or Faill ✓ R Pass ✓ ❑ Fail STMS - Sensor,o_n_,the.Evaporator Coil,.,,_----•-- . -_ -- r,..•-,.. _.. .......� System Name or Identification/Tag) / fI System 2 -1 ' I N rl ( ' � { f 1 1/ 3 ❑ Yes. ❑ X'I " ,l f The sensor is factory installed, orfieldinstalled according to' manufacturer.'s _ -„ specifications, or is installed by methods/specifications approved by the Executive Director. g �..' 1, - :'4 A �r 4 rl p.Yes / R, � ( _ Q No The sensor wire is terminated with astandard mini plug suitable for connection,to a',: digital'thermolneter. The sens& mini plug is accessible to the installing tecliniciai and the HERS rater without changing the airflow through the condenser coil ' - 5, 5, ❑ Yes . > ❑ No 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 ✓ Fj N/A ✓ ❑ Pass _F ✓ ❑ Fail 1 STMS - Sensor on the Condenser Coil, System Name or Identification/Tag System 2 The sensor is factory installed, or field installed according to manufacturer's 6 ❑ Yes ❑ No specifications, or is installed by methods/specifications approved by the Executive Director. The sensor wire is terminated with a standard mini plug suitable for connection to a 7 ❑ Yes ❑ No digital thermometer. The sensor mini plug is accessible to the installing technician and the HERS rater without changing the airflow through the condenser coil 8 ❑ Yes ❑ No When attached to a digital thermometer, the sensor provides an indication of the saturation temperature of the coil. Yes to 6, 7, and 8 is a pass. Enter N/A if STMS are not ✓ Gj N/A ✓ ❑ Pass ✓ ❑ Fail applicable. Otherwise enter Pass or Fail i Reg: 211-A0060384C-M2500001B-M25B Registration Date/Time: 2011/11/22 14:48:20 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 r Reg: 211-A0060384C-M2500001B-M25B Registration Date/Time: 2011/11/22 14:48:20 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 r r CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5) Site Address: Enforcement Agency: Permit Number: 78-515 Ave Ultimo, La Quinta CA 92253 City of La Quinta 11-1242 �7 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 forms) for any additional systems in the dwelling as applicable. • The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure. • The system must meet minimum airflow requirements as prerequisite for a valid refrigerant charge test. • If outdoor air dry-bulb is 55°F or below, the installer must use the Alternate Charge Measurement Procedure. Space Conditioning Systems System Name or Identification/Tag System 2 (must be re -calibrated monthly) (must be're-calibrated monthly) ,�',t� . ed Whole House Space Conditioning Systems System Name or Identification/Tag System 2 (must be re -calibrated monthly) (must be're-calibrated monthly) ,�',t� . S stem Location or Area Serv Y Outdoor Unit Serial # - 1005752566 Outdoor Unit Make Goodman - _ Outdoor Unit Model SSX160361 Nominal Cooling Capacity Btu/ hr 36000 ` Date of Verification ; 11/1/2011 cauoration OT uiagnostic instruments Date of Refrigerant Gauge Calibration Date of Thermocouple,Calibration ,,!'fir: 11/1/2011 11/1/2011 (must be re -calibrated monthly) (must be're-calibrated monthly) Measured Temperaturesl(;F) v .M•f. � r J f System Name or Identification/Tag � System 2 ,�',t� . Supply (evaporator leaving)'air dry-bulb"._-'^ 51.1 temperature (T supply, db) � _ Return (evaporator entering) air. dry-bulb 71.2 temperature (Treturn, db) , ] ` Return (evaporator entering) air wet -bulb 59.2 temperature (Treturn, wb) 'IN, i Evaporator saturation temperature 35 (Tevaporator, sat) Condensor saturation temperature 77 (Tcondensor, sat) Suction line temperature (Tsuction) 47 - Liquid Line Temperature (Tliquid) 65 Condenser (entering) air dry-bulb 71 temperature (Tcondenser, db) Reg: 211-A0060384C-M2500001B-M25B Registration Date/Time: 2011/11/22 14:48:20 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 { INSTALLATION CERTIFICATE CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5) Site Address: ommEnforcement Agency: Permit Number: 78-515 Ave Ultimo, La Quinta CA 92253 City of La Quinta 11-1242 Minimum Airflow Requirement Temperature Split Method Calculations for determining Minimum Airflow Requirement for Refrigerant Charge Verification. The temperature split method is specified in Reference Residential Appendix RA3.2. System Name or Identification/Tag System,2 Calculate: Actual Temperature Split = Tretum, 20.10 db - Tsupply, db Target Temperature Split from Table RA3.2-3 18.8 g using Tretum, wb and Tretum, db Calculate difference: Actual Temperature Split - 1.3 Target Temperature Split = Passes if difference is between -4°F and +4°F or, upon remeasurement, if between -4°F and PASS -100°F Enter Pass or Fail , Note: Temperature Split Method Calculation is not necessary if actual Cooling Coil Airflow is verified using one of the airflow measurement procedures specified in Reference Residential Appendix RA3.3. If actual cooling coil airflow is measured, the value must be equal to or greater than the Calculated Minimum Airflow Requirement in the table below. Calculated Minimum Airflow Requirement (CFM) = Nominal Cooling Capacity (ton) X 300 (cfm/ton) L System Name or Identiflcation/Teg� Calculated Minimum Airflow Requirement (CFM) Measured,Airflow using RA3.3 procedures (CFM) l Passes if measured airflow is greater than or, equal to the calculated minimum airflow- ` requirement. I. Enter Pass or Fail I Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for fixed orifice metering device systems System Name or Identification/Tag ' Calculate: Actual Superheat = , Tsuction - Tevaporator, sat Target Superheat from Table RA3.2-2 using Treturn, wb and Tcondenser, db Calculate difference: Actual Superheat - Target Superheat = System passes if difference is between -6°F and +6°F Enter Pass or Fail Reg:211-A0060384C-M2500001B-M25B Registration Date/Time: 2011/11/22 14:48:20 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:. 78-515 Ave Ultimo, La Quinta CA 92253 City of La Quinta 11-1242 Subcooling Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag System 2 Calculate: Actual Subcooling = 12.0 Tcondenser, sat - Tliquid ' Target Subcooling specified by manufacturer 12 Calculate difference: 0 Actual Subcooling - Target Subcooling = ' System passes if difference is between -4°F and +4°F PASS F Enter Pass or Fail PASS _ , Metering Device Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag System 2 Calculate: Actual Superheat = 1 12.0 Tsuction - Tevaporator, sat ' Enter allowable superheat range from ma6ufacturer's'specifications (or use range 12 between 3°F and 26°F if manufacturer's'- } specification is not available)„ System passes -if actual superheat is within the F allowable superheat range P / j PASS _ , Enter Pass or Fail ,I nyfpr�� p • � + I • • i �' � �� • dill i ��. � . ' •. t Reg: 211-A0060384C-M2500001B-M25B Registration Date/Time: 2011/11/22 14:48:20 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 . Y Reg: 211-A0060384C-M2500001B-M25B Registration Date/Time: 2011/11/22 14:48:20 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5) Site Address: Enforcement Agency: Permit Number:, 78-515 Ave Ultimo, La Quinta CA 92253 City of La Quinta 11-1242 Standard Charge Measurement Summary: System shall pass both refrigerant charge criteria, metering device criteria (if applicable), and minimum cooling coil airflow criteria based on measurements taken concurrently during system operation. If corrective actions were taken, all applicable verification criteria must be re -measured and/or recalculated. System Name or Identification/Tag System 2 179'1121 HERS Provider Data Registry Information - System meets all refrigerant charge and airflow ❑not -tested/ dwelling in (Certificate a HERS sample group requirements. ' PASS Athens Air ' Responsible Rater's Signature:. Enter Pass or Fail Aridr'ew Pulos Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 11/19/2011, CC2004503 " � r L 77 DECLARATION STATEMENT/ . I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. . I am the certified HERS rater who performed the verification services identified and reported on this certificate (responsible rater). . The installed feature, material, component, or manufactured device requiring HERS verification that is identified on this certificate (the installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified on the Certificate(s) of Compliance (CF -111) approved by the local enforcement agency. . The information reported on applicable sections of the Installation Certificate(s) (CF -611), signed and submitted by the person(s) responsible for the Installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -1R) approved by the enforcement aaencv. Builder or Installer information as shown on the Installation Certificate (CF -61111) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) UNIVERSAL MECHANICAL Responsible Person's Name: CSLB License: Jack Lyons r 179'1121 HERS Provider Data Registry Information Sample Group #:(if applicable): N/A ® tested/verified dwelling ❑not -tested/ dwelling in (Certificate a HERS sample group HERS Rater Information CaICERTS # CCl-1798609136 HERS Rater Company Name: Athens Air Responsible Rater's Name: Responsible Rater's Signature:. Andrew Pulos i Aridr'ew Pulos Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 11/19/2011, CC2004503 Reg: 211-A0060384C-M2500001B-M25B Registration Date/Time: 2011/11/22 14:48:20 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms , March 2010