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10-1374 (MECH)C- P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: r 10-.00001374 Property Address: 78970 INDIAN WOOD CT APN: 770-050-011-10 -25389 Application description: MECHANICAL Property Zoning: MEDIUM DENSITY RES Application valuation: 9500 Td -!t444" Appl' nt: Architect or Engineer: ------------------ LICENSED CONTRACTOR'S DECLARATION BUILDING & SAFETY DEPARTMENT BUILDING PERMIT I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License Class: C20 C36 License Oo.: 906115 Date: / Contractor:t. OWNER -8 ER DECLARATION I hereby affirm under penalty of perjury that I am exempt rom 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 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). (_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). 1 1 I am exempt under Sec. , B.&P.C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: _ Lender's Address: LQPERMIT Owner: AAKER DIANE 78970 INDIANWOOD CT LA QUINTA, CA 92253 (760)564-3102 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 12/16/10 ----------------------------------------------— WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier NORGUARD INS Policy Number CEWC133676 _ I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subjec o the workers' compensation laws of California, and agree that, if I should become subject e w kers' compensation provisions of Section 1 3700 of the Labor Code,I shall'forthwit om I ith those provisions. Date ✓.//�-� _Applicant WARNING: FAILURE TO SECURE WORKERS' CO PENS ON COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AN 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 and state laws relating to building construction, and her authorize representatives of this cMT;linature r upon the above-mentioned property for inspection o Dater (Applicant or Agent): I l Contractor: HYDES ! VJ l, 77825 WILDCAT STREET ! r:?-!� 1 v 2010 L_ PALM DESERT, CA 92211 (760)360-2202 f. ai.Y1H '�`:J Lic. No.. 906115° ----------------------------------------------— WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier NORGUARD INS Policy Number CEWC133676 _ I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subjec o the workers' compensation laws of California, and agree that, if I should become subject e w kers' compensation provisions of Section 1 3700 of the Labor Code,I shall'forthwit om I ith those provisions. Date ✓.//�-� _Applicant WARNING: FAILURE TO SECURE WORKERS' CO PENS ON COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AN 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 and state laws relating to building construction, and her authorize representatives of this cMT;linature r upon the above-mentioned property for inspection o Dater (Applicant or Agent): Application Number . . . . . 10-00001374 Permit . . . . . MECHANICAL Additional desc . . Permit Fee . . . . 51.00 Plan Check Fee 12.75 Issue Date . . . . Valuation . . . . 0 Expiration Date 6/14/11 Qty Unit Charge Per Extension BASE FEE 15.00. 2.00 9.0000 EA MECH FURNACE <=100K 18.00 2.00 9.0000 EA MECH B/C <=3HP/100K BTU 18.00 ---------------------------------------------------------------------------- Special Notes and Comments (2)HVAC CHANGE OUT (2)SYSTEMS SPLIT 16.. SEER (1) 3 TON & (1) 3 1/2 TON. 2007 CODES. ---------------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged ------------------------------------- Paid Credited -------------------- Due Permit Fee Total 51.00 .00 _00 51.00 Plan Check Total 12.75 .00 .00 12.75 Other Fee Total 1.00 .00 .00 1.00 Grand Total 64.75 • .00 .00 64.75 r W LQPERMIT r Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC CF -IR -ALT -HVAC Alterations Climate Zones 10 - 15 Site Address: Enforcement Agency: Date: Permit #: 78-970 Indian Wood La Quinta, CA 92253 1 City of La Quinta I Dec 15, 2010 Duct insulation Conditioned Floor Equipment Typel List Minimum Efficiency2 requirement Area Thermostat ❑ Package Unit 0 Furnace 0 Indoor Coil 0 AFUE 78% 0 SEER 13.0 ❑ COP ❑ HSPF ❑ R 6 (CZ 10-13) R 8 Served by system 1200 sf 0 Setback If not already present, 0 Condensing Unit ❑ EER L -] Resistance❑ (CZ 14 -IS) must be installed) ❑ Other 1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -1R -ALT -HVAC for each system. 2. Minimum Equipment Efficiencies: 13 SEER, 78% AFUE, 7.7HSPF for typical residential systems. HERS VERIFICATION SUMMARY Listed below are FOUR HVAC alteration Options. The installer decides what work is being done and picks one of the appropriate Options. Each Option lists the HERS measures that must be conducted. A copy of the forms shall be left on site for final inspection and a copy given to the homeowner. At final, the inspector verifies that the work listed on this form was in fact the work completed by the installer. The inspector also verifies that each appropriate CF -6R and registered CF -4R forms (no hand filled CF-4Rs allowed) are filled out and signed.Beginning October 1, 2010, a registered copy of the CF -IR and CF -6R shall also be on site for final inspection. ® 1. HVAC Changeout Required Forms: . All HVAC Equipment CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS replaced CF -4R forms: MECH-21 and (for split systems) MECH-25 . Condenser Coil and /or . Indoor Coil and /or CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS . Furnace CF -4R forms: MECH-21 and (for split systems) MECH-25 For Split Systems: Duct leakage < 15 percent; RC, CCA <_ 300 CFM/ton (Minimum Air Flow Requirement), TMAH For Packaged Units: Duct leakage < 15 percent Exempted from duct leagage 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. ExistincT ductsystems are_copstructedainsulated,or sealed witgasbestos ❑ 2 NeviHVAC i Require�&yFodtns: P System' . Cut in`or Changeout � «F �4 CF6R forms. MECH-04, MECtf-20 HERS, and -(for split systems) MECH-22 HERS and with new ducts: (all new d`ticbng r a�l�,' ° ,_ 2111111111 NIFCIi-25 HERS , CF=4ftfo�ms iNECH42O,;and MECH-224andIMECHI25, new equipment) (for�spliE systems) s For Split Systems: Duct leakage < 6 percent; RC, CCA >_ 350 CFM/ton, FWD, TMAH, STMS, and either HSPP or PSPP. For Packaged Units: Duct leakage < 6 percent ❑ 3. New Ducts with/or without Required Forms: Replacement . Includes replacing or installing all new ducting and/or outdoor condensing unit and/or indoor coil CF -6R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS and/or furnace. No or some CF -4R forms: MECH-20 and (for split systems) MECH-25 equipment changed. For Split Systems: Duct leakage < 6 percent; RC, CCA >_ 300 CFM/ton, TMAH For Packaged Units: Dud leakage < 6 percent ❑ 4. New Ducting over 40 feet Required Forms: . Includes adding or replacing more than 40 linear feet of duct in CF -6R forms: MECH-04, MECH-2I-HERS unconditioned space. CF -4R forms: MECH-21 For split system or packaged units: Dud leakage < 15 percent ❑ EXCEPTION: Existing dud 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: Mark Hyde Signature: Mark Hyde Company: CERTIFIED COMFORT SYSTEMS INC Date: Dec 15, 2010 Address: 77-825 WILDCAT DRIVE License: 906115 City/State/Zip: PALM DESERT / CA / 92211 Phone: (760) 360-2202 Reg: 210-A0031804A-00000000-0000 Registration Date/Time: 2010/12/15 18:50:03 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms July 2010 Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC CF-IR-ALT-HVAC Alterations Climate Zones 10 - 15 Site Address: Enforcement Agency: Date:Permit #: 78-970 Indian Wood (#2) La Quinta, CA 92253 City of La Quinta Dec 15, 2010 Duct insulation Conditioned Floor Equipment Typel List Minimum Efficiency2 requirement Area Thermostat ❑ Package Unit PlFurnace �'i Indoor Coil ® AFUE 78% 0 SEER 13.0 ❑ COP ❑ HSPF ❑ R 6 (CZ 10-13) R 8 Served by system 1300 sf 0 Setback If not already present, EZI Condensing Unit [-1EER El Resistance ❑ (CZ 14-15) must be installed) ❑ Other 1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF-IR-ALT-HVAC for each system. 2. Minimum Equipment Efficiencies: 13 SEER, 78% AFUE, 7.7HSPF for typical residential systems. HERS VERIFICATION SUMMARY Listed below are FOUR HVAC alteration Options. The installer decides what work is being done and picks one of the appropriate Options. Each Option lists the HERS measures that must be conducted. A copy of the forms shall be left on site for final inspection and a copy given to the homeowner. At final, the inspector verifies that the work listed on this form was in fact the work completed by the installer. The inspector also verifies that each appropriate CF-6R and registered CF-4R forms (no hand filled CF-4Rs allowed) are filled out and signed.Beginning October 1, 2010, a registered copy of the CF-111 and CF-6R shall also be on site for final inspection. 0 1. HVAC Changeout Required Forms: • All HVAC Equipment CF-6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS replaced CF-4R forms: MECH-21 and (for split systems) MECH-25 • Condenser Coil and /or CF-6R forms: MECH-04, MECH-2I-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 For Packaged Units: Duct leakage < 15 percent Exempted from duct leagage 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;°insulate.2o osealed wio asbestos ❑ 2 New!HVAC i Require:d'For'ms: t Systems " 1 . Cut in'or,:Changeout 1 Wiz, with new ducts: (all: ria "P' ' split systems) MECH-22 ]HERS, and CFY 6R fiprmsc�MECH-04, MECH720-HERS, and (fSEGH722A,#K�d�MECH; �IECH 25-HERS new ducting mall ,.S CF-4R,fo�ms: MECHALO -and (for ystems) 25 ° new equipment)'%, t :., —.� For Split Systems: Duct leakage < 6 percent; RC, CCA >_ 350 CFM/ton, FWD, TMAH, STMS, and either HSPP or PSPP. For Packaged Units: Duct leakage < 6 percent ❑ 3. New Ducts with/or without Required Forms: Replacement . Includes replacing or installing all new ducting and/or outdoor condensing unit and/or indoor coil CF-6R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS and/or furnace. No or some CF-4R forms: MECH-20 and (for split systems) MECH-25 equipment changed. For Split Systems: Duct leakage < 6 percent; RC, CCA >_ 300 CFM/ton, TMAH For Packaged Units: Duct leakage < 6 percent ❑ 4. New Ducting over 40 feet Required Forms: . Includes adding or replacing more CF-6R forms: MECH-04, MECH-2I-HERS than 40 linear feet of duct in CF-4R forms: MECH-21 unconditioned space. 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: Mark Hyde Signature: Mark Hyde Company: CERTIFIED COMFORT SYSTEMS INC Date: Dec 15, 2010 Address: 77-825 WILDCAT DRIVE License: 906115 City/State/Zip: PALM DESERT / CA / 92211 Phone: (760) 360-2202 Reg: 210-A0031807A-00000000-0000 Registration Date/Time: 2010/12/15 19:00:03 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms July 2010 V, ;ERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-2: )uct Leakage Test— Existing Duct System (Page 1 of 2 Site Address: Enforcement Agency: Permit Number: 78-970 Indian Wood, La Quinta CA 92253 (System 1) City of La Quinta 10-1374 anter the Duct System Name or Identification/Tag: anter the Duct System Location or Area Served: lote: Submit one Installation Certificate for each duct system that must demonstrate compliance in the Welling. This installation certificate is required for compliance for alterations and additions in existing dwellings to space conditioning systems and duct systems. lote: For existing dwellings, a completely new or replacement duct system can also include existing parts o. he original duct system (e.g., register boots, air handler, coil, plenums, etc.) if those parts are accessible ,nd they can be sealed. For a completely new or replacement duct system installed in an existing dwelling, rse the Installation Certificate titled "Duct Leakage Test - Completely New or Replacement Duct System. " Duct Leakaqe Diaqnostic Test - existinq duct system Select one compliance method from the following four choices. ❑ 1. Measured leakage less than 15% of fan flow ❑ 2. Measured leakage to outside less than 10% of Fan Flow /I conduct ❑ 3. Reduce leakage by 60% and smoke and fix all leaks ❑ 4.'Fix,all accessible leaks using smoke and HERS rater verify Note:ti(One of Options 1, 2, or 3 must'be attempted before utilizing Option 4.) Determine n�{nahFan;Flow using onee'of thhe,followingythreelcalculation i methods. ✓ ElCool+ng system method: Size of condenser in Tons , z 400 = - CFM - r` ` ,rye`- -t,• s: f -;.( k ✓ EJ Heating system method' 21.7 xLL-'Output Capacity in Thousands of Btu/hr = CFM _ procedures: � ~� ✓ ❑ Measured system airflow using "3.3 airflow test CFM "`�� + Y 9 4 i p � .. r <'" �-t f x r Option l used then. +r + : '~.+w` r- .. w . is "� - _ = "-';° (11,91.. 1 Allowed leakage Fanflow x 0.15 _ _ CFM, Actual Leakage— _ CFM ' Pass if Leakage Actual is less than Allowed E] Pass ❑ Fail Option 2 used then: 2 Allowed leakage = Fan Flow x 0.10 = _ CFM Actual Leakage to outside = CFM <_ J 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% _ No Reduction Pass if % Reduction > 60% ❑ Pass ❑ Fail Option 4 used then: 4 All accessible leaks repaired using smoke. HERS rater must verify (No sampling). No smoke allowed to leak from system. Including ducts, plenums, air handler and door panel. -- Pass if all accessible leaks have been repaired using smoke ❑ Pass ❑ Fail Reg: 210-A0031804A-M2100001A-M21A Registration Date/Time: 2011/01/24 12:45:54 HERS Provider: CalCERTS, 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: 78-970 Indian Wood, La Quinta CA 92253 (System 1) 1 City of La Quinta 10-1374 i ❑ 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 co6figured,toithe closed position. duringyduct leakage,testing. ❑ All supplyand return regiisRter:boots',must be sealed to the drywall'if smoke test is utilized for. compliance — applies.to duct leakage compliance option 3 (leakage} eduction by460%) and option 47(fix all accessible '=-- leaks) described above. f Y ❑ New d'uct,installations cannot utlllze'building;Cavities;as plenums or platform returns Inlieu ofrducts,t, ❑ Mastic and draw bands must be used in combination with cloth backed rubber adhesive duct tape to seal leaks at all,new{di ct connections DECLARATION STATEMENT . I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. • I am the certified HERS rater who performed the verification services identified and reported on this certificate (responsible rater). • The installed feature, material, component, or manufactured device requiring HERS verification that is identified on this certificate (the installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified on the Certificate(s) of Compliance (CF -SR) approved by the local enforcement agency. • The information reported on applicable sections of the Installation Certificate(s) (CF -6R), 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 agency. Builder or Installer information as shown on the Installation Certificate (CF -6111) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) CERTIFIED COMFORT SYSTEMS INC Responsible Person's Name: CSLB License: Mark Hyde 1906115 HERS Provider Data Registry Information Sample Group # (if applicable): 189128 ❑ tested/verified dwelling not-tested/verified dwelling in la HERS sample group HERS Rater Information CalCERTS Certificate # CC1-1798529392 HERS Rater Company Name: Desert H.E.R.S. Raters Responsible Rater's Name: Responsible Rater's Signature: Michael Hyde Michael Hyde Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 1/5/2011 CC2005602 Reg: 210-A0031804A-M2100001A-M21A Registration Date/Time: 2011/01/24 12:45:54 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 5) Site Address: Enforcement Agency: Permit Number: 78-970 Indian Wood, La Quinta CA 92253 City of La Quinta 10-1374 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 r „0;r 11 i ; ! ' t;' System Location or Area Served ❑ YesF 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-Land_2 is a pass. Enter Pass or Faill ✓ ❑ Pass ✓ ❑Fail STMS = Sensor.on,the, Evaporator System Nameror Identification/Tag'- r „0;r 11 i ; ! ' t;' 3 ❑ YesF ❑ No /j ff .": ) The sensor is factory installed, orifield installed' according to manufacturer's - specifications, or is°installed by method's/specifications approved by4the Executive Director. 4 t,,,�¢:h p,Yes -- �'3': ley. R p No' The sensor wire is terminated with a standard mini plug suitable for connection,to a digital thermometer: Thesens6r mini plug is accessible to the-insfalling tec nieian � and the HERS rater without changing the airflow through the condenser coil 5 f ❑ Yeses ❑ No + L J 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 ❑ N/A ✓ ❑ Pass ✓ ❑ Fail STMS - Sensor on the Condenser Coil System Name or Identification/Tag 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 ✓ D N/A ✓ E] Pass ✓ ❑Fail applicable. Otherwise enter Pass or Fail Reg: 210-A0031804A-M2500601A-M25A Registration Date/Time: 2011/01/24 12:51:22 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5) Permit Number: Site Address: Enforcement Agency: 78-970 Indian Wood, La Quinta CA 92253 City of La Quinta 10-1374 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 Conditioninq Svstems System Name or Identification/Tag 210=A0031804A-M2500001A-M25A (must be re -calibrated monthly) Date of hermocouplelCalibration l A - - System Location or Area Served March 2010 Outdoor Unit Serial # Outdoor Unit Make Outdoor Unit Model Nominal Cooling Capacity Btu/hr I Date of Verification Gaimratlon oT wiagnostic instruments Date of Refrigerant Gauge Calibration 210=A0031804A-M2500001A-M25A (must be re -calibrated monthly) Date of hermocouplelCalibration l A - - ((must be ri-calibrated monthly) Measured Temperatures,(9F) f i ., F l f _C f i• System Name or Identification/Tag`, i � 210=A0031804A-M2500001A-M25A Registration Date/Time: 2011/01/24 12:51:22 HERS Provider: CalCERTS, Inc. Residential Compliance Forms March 2010 Supply'(evaporator leaving) air dry-bulb i temperature (Tsupply, db) Return (evaporator -'entering) air dry-bulb temperature (Treturn, db) Return (evaporator entering) air wet -bulb temperature (Treturn, Wb) - 11 i Evaporator saturation temperature• (Tevaporator, sat) Condensor saturation temperature (Tcondensor, sat) Suction line temperature (Tsuction) Liquid Line Temperature (Tliquid) Condenser (entering) air dry-bulb temperature (Tcondenser, db) Reg: 210=A0031804A-M2500001A-M25A Registration Date/Time: 2011/01/24 12:51:22 HERS Provider: CalCERTS, 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: Enforcement Agency: Permit Number: 78-970 Indian Wood, La Quinta CA 92253 City of La Quinta 10-1374 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 Calculate: Actual Temperature Split = Treturn, db ' Tsupply, db Target Temperature Split from Table RA3.2-3 using Treturn, wb and Treturn, db Calculate difference: Actual Temperature Split - Target Temperature Split = Passes if difference is between -4°F and +4°F or, upon remeasurement, if between -4°F and -100°F Enter Pass or Fail Note: Temperature Split Methdd.Cakulation 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. 1 Calculated Minimum Airflow Requirement (CFM) = Nominal Cooling Capacity (ton) X 300 (dm/ton) t # 4.� System Name or.°Identification/Tag Calculated Minimum Airflow Requirement (CFM) t Measured Airflow usin ,RA3 3 procedures (CFM) Passes'if measured airflow is greater than'or equal e= to the calculated minimum airflow requirement: J 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 4 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: 210-A0031804A-M2500001A-M25A Registration Date/Time: 2011/01/24 12:51:22 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-4R-MECH-2! Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of S' Site Address: . Enforcement Agency: Permit Number: 78-970 Indian Wood, La Quinta CA 92253 City of La Quinta 10-1374 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 Calculate: Actual Subcooling = Tcondenser, sat - Tliquid Target Subcooling specified by manufacturer Calculate difference: Actual Subcooling - Target Subcooling = System passes if difference is between -4°F and +4°F Enter Pass or Fail � `� t tl� j "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 Calculate: Actual Superheat = I Tsuction - Tevaporator, sat Enter allowable superheat range from manufacturer's specifications (or use range between 3°F and 26°F if manufacturer's specification is not available) System 'passds,,ifactual 'superheat is'withinrhe � `� t tl� j "r .' allowable superheat range _ ,.Enter,Pass or Fail C Reg: 210-A0031804A-M2500001A-M25A Registration Date/Time: 2011/01/24 12:51:22 HERS Provider: CalCERTS, 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: 78-970 Indian Wood, La Quinta CA 92253 City of La Quinta 10-1374 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 Mark Hyde 1906115 HERS Provider Data Registry Information Sample Group # (if applicable): 189128 System meets all refrigerant charge and airflow not-tested/verified dwelling in la HERS sample group requirements. HERS Rater Company Name: Desert H.E.R.S. Raters Responsible Rater's Name: Responsible Rater's Signature: / Enter Pass or Fail Michael Hyde Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 1/5/2011 CC2005602 I DECLARATION STATEMENT, . I certify under penalty of perjury, under the laws of the State of California; the information provided on this form is true and correct. • I am the certified HERS rater who performed the verification services identified and reported on this certificate (responsible rater). • The installed feature, material, component, or manufactured device requiring HERS verification that is identified on this certificate (the installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified on the Certificate(s) of Compliance (CF -SR) approved by the local enforcement agency. • The information reported on applicable sections of the Installation Certificate(s) (CF -611), signed and submitted by the person(s) responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -111) approved by the enforcement agency. Builder or Installer information as shown on the Installation Certificate (CF -6R) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) CERTIFIED COMFORT SYSTEMS INC Responsible Person's Name: CSLB License: Mark Hyde 1906115 HERS Provider Data Registry Information Sample Group # (if applicable): 189128 ❑ tested/verified dwelling not-tested/verified dwelling in la HERS sample group HERS Rater Information CalCERTS Certificate # CC1-1798529392 HERS Rater Company Name: Desert H.E.R.S. Raters Responsible Rater's Name: Responsible Rater's Signature: / Michael Hyde Michael Hyde Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 1/5/2011 CC2005602 Reg: 210-A0031804A-M2500001A-M25A Registration Date/Time: 2011/01/24 12:51:22 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 Bin # City of La Quinta Building & Safety Division Permit # P.O. Box 1504, 78-495 Calle Tampito La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet, Project Address:' Owner's Name: A P. Number Address: Legal Description Cl/, City, ST, Zip: ✓/..,, . 9F �3 Contractor. ��,-�t.tl • �o��n J C Telephone: ?� ` j�•� Address: • �?' 7%j � � G' Project L Description: tlAC e— -o City, ST, zip: fGe Q 7 . Telephone• �Ep � �j�. •120 Z � . State Lic. # : �% ��-� City Lic. #: C �A Arch., F,wy Designer: Address: �' �v N • City, ST, Zip: Telephone: Construction Type: Occupancy: Stale Lia #: Project type (circle one): New Add, Al Repair' Demo Name of Contact Person: Goe Sq. Ft: �� 1! # Stories: # Units: Z Telephone # of Contact Person• �' �'j�� Z-, F�� Valun 5-oo of Project APPLICANT: DO NOT WRITE BELOW THIS UNE # Submittal Roq'd Recd TRACMG • PERMIT FEES Plan Sets Plan Check submitted Item ICalled Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Contact Person Plan Check Balance Energy Calces Pians picked up Construction Flood plain plan Plan resubmitted Mechanical Gradingpin 2'' Review, ready for correctionstissae Electrical Subcoutactor List Called Contact Person Plumbing Grant Deed Plan picked up S.M,L SOA Approval Plan resubmitted Grading INHOUSE:- 7n° Review, ready for corrections/issue er Impact Fee Plannin Approval Called Contact Person .P. Pub. Wks. Appr Date of permit issue School Fees tT'tWdPermit Fees