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11-1201 (MECH)23 P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: C11-000012-61.;-. Property Address: 78292 CALLE LAS RAMBLAS APN: 770-015-006- - Application description: MECHANICAL Property Zoning: LOW DENSITY .RESIDENTIAL Application valuation: 16456 Applicant: Ta!t 4 Xi& QuAM Architect or Engineer: alp BUILDING & SAFETY DEPARTMENT . BUILDING PERMIT • LICENSED CONTRACTOR'S DECLARATION 1 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 rofessionals Code, and my License is in full force and effect. License Class: C20 License No.: 686310 11� /►1 ate: / ractor: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000)'of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant.for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: (_ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself of herself through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). 1 _ 1 1, 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: . DALPORTO DONALD 78292 CALLE LAS RAMBLAS LA QUINTA, CA 92253 Contractor: GENERAL AIR CONDITIONING 31170 RESERVE DRIVE THOUSAND PALMS, CA 92276 (760)343-7488 Lic. No.: 686310 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 11/03/11 �vtrn3 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 ZENITH INS CO Policy Number Z071741501 I certify that, in the performance of the work r which this permit is issued, I shall not employ any person in any manner so as to become su I ct to the workers' compensation laws of California, " and agree that, if I should become subje [he workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwit mply " 'th those provisions. Date: if 3 pplicant: WARNING: FAI URCURE WORKE MPE SATION 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, indemnity 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 ce tion of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above inform io is correct. I agree to comply with all city and county ordinances and state laws relating to building construct and her by authorize representatives 7s 's county to enter upon t e above-mentioned property for inspecti urpos . Date: % %Z,3Zn Si ture (Applicant or Agent): X Application Number . . . . . 11-00001201 Permit . . . MECHANICAL Additional desc . . Permit Fee . . . . 66.00 Plan Check Fee 16.50 Issue Date Valuation 0 Expiration Date 5/01/12 Qty Unit Charge Per Extension BASE FEE 15.00 2.00 9.0000 EA MECH FURNACE <=100K 18.00 .2.00 16.5000 EA MECH B/C >3-15HP/>100K-500KBTU 33.00 ---------------------------------------------------------------------------- Special Notes and Comments NEW 3 TON & 4 TON HVAC SYSTEMS: CONDENSERS, COILS, FURNACES. 2010 CODES. ---------------------------------------------------------------------------- Other Fees. . . . . . . . . . BLDG STDS ADMIN.(SB1473) 1.00 Fee summary Charged ------------------------------------- Paid Credited -------------------- Due Permit Fee Total 66.00 .00 .00 66.00 Plan Check Total 16.50 .00 .00 16.50 Other Fee Total 1.00 .00 .00 1.00 Grand Total 83.50 .00 .00 83.50 LQPERMIT Simplified Prescriptive Certificate of Compli Climate Zones 10 to 15 Site Address: Equipment T et List Minimum Efficiency ❑ Packaged Unit ndoor Coil ondensing Unit Residential HVACAlterations CF4R-ALT-HVAC dbrce t Agency: Date: Permit tl: Conditioned Floor Duct insulation requirement Area Thermostat ❑ AFl1E 80% 1 ❑ COp Over 40 ft of ducts added or ,Setback ❑SEER 13 ❑ HSPF replaced in unconditioned space Served by system (lfnot already ❑ EER / / ❑ Resistance ❑ R 6 (CZ 10-13) sf present, mast be ❑ R 8 (CZ 14-15) 1 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 of the fortes 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 -411 forms (no hand filled CF-4Rs allowed) are filled out and it, ed. Be innin October 1, 201.0, a re istered co of the CF -1R and CF -6R shall also be on site for final ins ection. . HVAC Changeout Required Forms: • All HVAC Equipment replaced CF -6R fortes: MECH-04, MECH-2I-HERS and (for split systems) MECH- 25 -HERS - CF -4R forms: MECH- 2 F and fors lits stems MECH-25 • Condenser Coil and/or • Indoor Coil and/or CF-611forms: 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 Exempte fr m duct leakage testing if: I. uct 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. Existin ducts stems are constructed, insulated or sealed with asbestos ❑ 2. New HVAC System Required Forms: • Cut in or Charigeout 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) CF -4R forms: MECH 20-, and (for split systems)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 I 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 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 CFM/ton, TMAH For Packaged Units: Duct leakage < 6 percent ❑ 4. New Ducting over 40 feet Required Forms: • Includes adding or replacing more than 40 CF -6R forms: MECH-04, MECH-2I-HERS CF -4R forms: MECH-21 linear feet of duct in unconditioned space. 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 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. • 1 certify that the energy features and performance specifications for the design identified on this Certificatebf Compliance conform to the requirements of Title 24, Parts I and 6 of the California Code of Regulations. • The design features identified on this Certificate of Compliance are consistent with the �flrm, tion documented on other pplic ompliance forms, worksheets, calculations, lans ands ecifications submitted to the enforcement a enc fora ro ale ermit application. Name: Co Ileeli I,(f �� Si ture: Company: �� Date: r Condi f•`o.�,` Address: n_ 3/f 70 /Zeserue Cr�`rt �� License: City/State/Zip: - r—�Q� ' / 6t.`h�S, G1�i 9a�� Phone: 7&0'.3`�3--74 LUUn Kesidential (,ompliance Forms Simplified Prescriptive Certificate of Compliance: 2008 Residential HVACAIterations CF -IR -ALT -HVAC Climate Zones 10 to 15' Site Address: En rcem Agenc : Date: Permit #: Equipment ni e� List Minimum Efficiez nc Duct insulation requirement Conditioned Floor Area Thermostat _ ackaged ed Unit urnace AFUE W70 []COP Over 40 ft of ducts added or aced in unconditioned space Served by system Setback Indoor Coil Condensin �L HSPF R 6 CZ 10-13 ( ! ff"; sf (1 nor already present, must be g Unit []EER t./ Resistance ther R 8 (CZ /4-I5) installed) /. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -/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 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 si ed. Beginning October 1, 2010, a registered copy of the CF -1R and CF -6R shall also be on site for final inspection. 10 1. HVAC Changeout Required Forms: N'ktl 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 and7or • 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. Exempt d f m duct leakage testing if: io 1. Duct system was documented to have been previously sealed and confirmed through HERS verification, or 'Int -Duct systems with less than 40 linear feet in unconditioned space, or _., 3. Existing ducts stems are constructed, insulated or sealed with asbestos Q 2. New HVAC System Required Forms: • Cut in or Changeout with new ducts: (all new ducting and all CF -6R forms: MECH-04, MECH-20-14ERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS new equipment) CF -4R forms: MECH 20-, and (for split systems)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/or without 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 coil CF -4R forms; MECH-20 and (for split systems) MECH-25 and/or furnace. No or some equipment changed. For Split Systems: Duct leakage < 6 percent, RC, CCA > 300 CFM/ton, TMAH For Packaged Units: Duct leakage < 6 percent 4. New Ducting over 40 feet Required Forms: • Includes adding or replacing more than 40 linear feet.of duct in unconditioned space. CF -6R forms: MECH-04, MECH-2I-HERS CF -4R forms: MECH-21 For split s stem 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 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 I and 6 of the California Code of Regulations. • The design features identified on this Certificate of Compliance are consistent with the inform m d cumented on oth applicable complianceforms, worksheets, calculate s plans ands ecificati ns submitted to the enforcement agency for roval with t e e t application. Name: Ij Signature: Company: Date: Address: Q —e License: City/State/Zip: (._ Phone: �� S`f3Vk*SZII 2008 Residential Compliance Forms March 2010 CaICERTS - CF -1R Registration Page 1 of 1 Public Home Secure Home About Us Training Rater Directory Forms Membership Benefits Events Industry Partners News To register for our monthly newsletter, please click here. Danielle Garcia logged in [Logout) [Home] CONGRATULATIONS Your CF -1 R -ALT -HVAC Registration is complete! You may want to print this page for your records. Site Address: 78292 CALLE LAS RAMBLAS La Quinta, CA 92253 CEC Registration: 211-A0057107A-00000000-0000 CF -IR -ALT -HVAC: CLICK HERE TO DOWNLOAD Assigned Company: HARRISON ENTERPRISES INC Do you know your HERS Rater? If you do, you may want to send this CF -1R to them. CaICERTS Rater ID: _OR_ My Rater Quick Select: Energy Driven Solutions, Inc. Every CaICERTS rater has a license number. lfyou need to find the rater by name [Click HERE] to search our directory. I wa+�SEND CF,tR TO HERS: RATER.,..,:v I [CLICK HERE] to do another Copyright (() 2010 CalCE:RTS. Inc. All rights reserved. Revised: January 11. 2010 [Terms and Conditions] [Privacy Statement] [Class Cancellation Policy_] CaICERTS, Inc., 31 Natoma St Suite 120, Folsom, CA 95630 Office: 916-985-3400,Toll Free: 877-HERS-R8R, (877-437-7787) Fax: 916-985-3402 Contact Us BBB Frtt4"cnF4 'b.OQk.©� httnc•//www ralrPrtc rnm/niihlir. rfl R rf 9nrniPrt id=147479 11 /9/7(11 1 C410ERTS-.CF-1R Registration Page 1 -of -1 Public Home Secure Home About Us Training Rater Directory Forms, Membership Benefits Events Industry Partners News To register for our monthly . newsletter, please click here. Danielle Garcia logged in [Logout/ [Home] CONGRATULATIONS Your CF -IR -ALT -HVAC Registration is complete! You may want to print this page for your records. Site Address: 78292 CALLE LAS RAMBLAS La Quinta, CA 92253 CEC Registration: 211-A0057109A-00000000-0000 CF -IR -ALT -HVAC: CLICK HERE TO DOWNLOAD Assigned Company: I HARRISON ENTERPRISES INC _ Do you know your HERS Rater? If you do, -you may want to send this CF -1R to them. - Ca10ERTS Rater ID: OR__ _ My Rater Quick Select:1 Energy Driven_Solutions, Inc. Every CaICERTS rater has a license number. Ifyou need to find the rater by name [Click HERE] to search our directory. L_:;tSENp CF,;1R,7TQ HERS_ RATE..R�,;;» j [CLICK HERE] to do another Copyright 02010 CalCr:R"fS, Inc. All rights reserved. Revised: January 11. 2010 [Terms and Conditions] [Privacy Statement] [Class Cancellation Policy] CalCERTS, Inc., 31 Natoma St Suite 120, Folsom, CA 95630 Office: 916-985-3400,Toll Free: 877-HERS-R8R, (877-437-7787) Fax: 916-985-3402 Contact Us T BBB rind us on Eaceb9okli. i https://www.calcerts.com/public cflR.cfrn?Droiect id=147481 11/2/2011 SII FINANCING THROUGH:. REQ GENERAL *- Air. Conditioning & Heating - 31-170 Reserve Drive • Thousand Palms, CA 92276 (760) 343-7488 • Fax (760) 343-7494 www.callthegeneral.com Residential Comfort Survey INSTALL DATE 'r l t I JOB# O CUSTOMER# [OW S- MW" JOB A] CITY_ PHONE _?(U-�i ( CELL FAX SEPARATE BILLING ADDRESS? ❑ YES ❑ NO r ` NE` " gQ11TPiVIE1VT COND FAU Sia- 0(A COIL (R-3% �-4� zu TSTAT pre �tocQL�c FILTRATION S� MISC PERMIT S DUCT WO NOTES CK. NO ❑ NO rt --Z,41 EXISTING EQUIPMENT COND M # FAUM# COIL M# UNIT LOCATION: S# S# S# CRANE? Cl YES ❑ NO SIZE WARRANTY PLATFORM SIZE ATTIC HEIGHT OPENING ❑ FINANCING DAYS ❑ CREDIT CARD ❑ C.O.D. ❑ COSTCO (tin # - - Qty of La Quinta Building 8i• Safety Dh4slon Permit # p\ P.O. Box 15.04, 78-495 Calle Tampico Y" La Quinta, CA 92253 - (760) 777-7012 Building Permit. APPlication and Tracking Sheet Project Address: Owner's Name: A. P. Number - Address: Address: .2- 66W--- � /4- ,,6`[ 3 Legal Description:.• Contractor:;w...,µs City, ST, Zip: La- Q��— �—•! �' Tele > y .R ' •< < ay Address: y City, ST, Zip: Project Description: Tel State Lie. # : ?.+C.4iy ii lt.iYrtii •L: , is C4£r:if f i;%<,%`!'4°'` 3 City Lie. C Arch., Engr., Designer: Address: City., ST, Zip: Telephone:. State Lie. #%%''%;":rrr`.',,�, Name of Contact•Person:�✓t :.—77 �.. J 57 .../.•;y,,::,,.f ` :yss as:.r .:.y::...:�..r.:.. i'rY4�. c ; S DYU nsucton Type: Occupancy: Project a circle one New Add"n Alter Repair Demo :1 type ( )• Sq. Ft.: #Stories: Telephone # of Contact Person: -76, O 3 Y3 %" �' g Estimated Value of Project: (p_ # Submittal APPLICANT: DO. NOT -WRITE -BELOW THIS LINE Req'd Recd TRACHING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cafes. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance. Title 24 Cafes. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2"a Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing . Grant Deed Plans picked up. $.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- 7rd Review, ready for correctionstissue Developer Impact Fee Planning Approval Called Contact Person Pub. Wks. Appr Date ofperm (t issue School, Fees Total Permit Fees CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-21 Duct Leakage Test — Existing Duct System (Page 1 of 2) Site Address: 78292 CALLE LAS RAMBLAS, La Quinta CA 92253 (System Enforcement Agency: Permit Number: 1) City .of La Quinta 11-1201 Enter the Duct System Name or Identification/Tag: Enter the Duct System Location or Area Served: 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 - existina duct system Select one compliance method from the following four choices. 1. Measured leakage less than_15% of fan. flow----..-.- low----..__-❑ E]2. Measured leakage to outside less than 10% of Fan Flow S ❑ 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 mustbe attempted before.,utilizing Option4.:),. t .�sq,ti^1 , Determine nominal'Fan'Flow using one ofitheJollowing_thi�ee. calculation methods .,,Cr- r— d^ ❑ Cooling system method: Size of,con'denser in Tons x 400 = CFM V ❑ Heating system method: 213 x -t Output Capacity m,Thousands of Btu/hr = CFM - ,� �l .'�. 'C ❑ Measured,system airflow.using RA3_3 airflow=`test procedures: • CFM .• Option 11 .used.+then,"'In �^ :;, 1 Allowed leakage = Fan Flow x 0.15 _ _CFM Actual. Leakage -i- _ CFM Pass if Leakage Actual is less than Allowed Pass 0 Fail Option 2 used then: Y Allowed leakage Fan 2 = Flow x 0.10 = _ CFM Actual Leakage to outside.= s_' '' CFM Pass if Leakage Actual is less than Allowed Pass Fail Option 3 used then: Initial leakage prior to start of work = CFM Final leakage after sealing all accessible leaks using smoke test = _ CFM 3 Initial leakage _ - Final leakage _ = Leakage reduction CFM ((Leakage reduction _/'Initial leakage x 100% = o 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 El Pass p Fail Reg: 211-A0057107A-M2100001A-M21A Registration Date/Time: 2011/12/02 18:35:23 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: Responsible Person's Name: CSLB License: 78292 CALLE LAS RAMBLAS, La Quintal CA 92253 (System Enforcement Agency: Permit Number: 1) City of La Quinta 11-1201 __.. _.._ ❑ 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 4boots must b'e seal#ed to the drywallif smoke tesf`is utlUzed for compliance - applies to duct leakage compliance option 3 (leakage reduction by=60%);and opti6n`4�(Wali accessible leaks) described above rd ❑ New duct;install"abons•,cannot utilize building cavities asfplenumslor,�platform+returns in lieu of.�)duc}ts IV ❑ Mastic andaw -band"s`must-be usedJn combination with cloth~backed rubber"adhe °drve ducty'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.: . I am the certified HERS rater who. p'eiformed 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 -SR), signed and submitted by the person(s) responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF-iR) approved by the enforcement agency. Builder or Installer information as shown on the Installation Certificate (CF -6R) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) HARRISON ENTERPRISES INC Responsible Person's Name: CSLB License: Danielle Garcia 1686310 HERS Provider Data Registry Information Sample Group # (if applicable): 258029 ❑ tested/verified dwelling la not-tested/verified dwelling in HERS sample group HERS Rater Information CalCERTS Certificate # CCi-1798604826 HERS Rater Company Name: Energy Driven Solutions, Inc. Responsible Rater's Name: Responsible Rater's Signature: David Bricker David Bricker Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 11/30/2011 CC2004131 Reg: 211-A0057107A-M2100001A-M21A Registration Date/Time: 2011/12/02 18:35:23 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: 78292 CALLE LAS RAMBLAS, La Quinta CA 92253 City of La Quinta 11-1201 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 Location or Area Served 3 Yes_ 'E] No•..__ _ 5/16 inch (8 mm) access hole upstream of evaporative. coil in the return plenum and labeled accoFdinq to_Figure+in Section RA3"2:2:217-- :2 2"— -2 2 ❑ Yes ❑ Non5/16 '" 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 Fail ✓ ❑ Pass ✓ ❑ Fail STMS - Sensor.on=the. Evaporator Coil System Namebrldentifcation/Tag% , , . V41 ) 3 f ❑kYes p`No� The sensor is factory installed, orifield installed according to`manufacturer's specifications, or is installed by methods/§pecifications approved by the Executive ❑ Yes ' specifications, or is installed by methods/specifications approved by the Executive D,irettor. ,, 4 ❑ Yes ids ,W � - tp No The sensor wire is term inated.with a standard:mini"plug suitable for connection;to a ` " digital.thermometer ,Th`esensor mini plug is"accessible to"the°installing'techniean �.# -� ;tl and"the HERS rater, without changing the'airflow through the condenser coil 5 ❑Yes,.--° , ❑ No j When attached to a digital thermometer, the sensor provides an indication of the ,w.- .., ...F ., . r`� saturation temperature of the coil. Yes to 3,•4, and 5 is a pass. Enter N/A if STMS are not applicable. Otherwise enteeRass or,Fail ✓ ❑ N/A ✓ ❑ Pass ✓ E]Fail f..k 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: 211-A0057107A-M2500001A-M25A Registration Date/Time: 2011/12/02 18:37:45 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5) Site Address: Enforcement Agency,: Permit Number: 78292 CALLE LAS RAMBLAS, La Quinta CA 92253 City of La Quinta 11-1201 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 Conditioninq Svstems System Name or Identification/Tag (must be re -calibrated monthly) System Location or Area Served /�'-•, a$..,� Date of ThermocoupleJGalibration f `ka.q. K P Y r.a :(must be re -calibrated monthly) Outdoor Unit Serial # Y *- ~'s � •,f ., "rte- �.. Outdoor Unit Make 3 _,,. Outdoor Unit Model Narotrial C:604 CaNacity Btu/hr— tu/hr—Date Dateof Verification ss %.mioration or uiagnosxic 1nsxruments V,; Date 'of Refrigerant Gauge Calibration (must be re -calibrated monthly) /�'-•, a$..,� Date of ThermocoupleJGalibration f `ka.q. K P Y r.a :(must be re -calibrated monthly) Supply (evaporator leaving);aiir,dryTbulb `(Tsupply, measurea.iemperaxures-t,,,rIN;,,,+ * 7 ^ A. ai ! ,. 4r-4 System Name or Ident (cation/Tag Supply (evaporator leaving);aiir,dryTbulb `(Tsupply, Y *- ~'s � •,f ., "rte- �.. temperature db) 3 _,,. Return (evaporator -entering) airdry;bulb temperat e (Treturn, db), Return (evaporator entering) air wet -bulb temperature (Treturn, wb) ' ,,, it'_ ::. 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: 211-A0057107A-M2500001A-M25A Registration Date/Time: 2011/12/02 18:37:45 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: 78292 CALLE LAS RAMBLAS, La Quinta CA 92253 City of La Quinta 11-1201 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 No La�,.Tgmopr,ature S-plit.Method .Calculaticn is, not ngces�ary_if cjctual__C..wlino Co irfl7ow is, verified using, one 0L .. _, airflow measurement procedures specif i -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 q ( CFM ) =Nominal Cooling Capacity (ton) X 300 (cfm/ton) System Name,or;Icl ratification/Tag - _,,Z,77 ._ Calculated Minimum Airflow,Requirement (CFM) ,+ MeasuredAirflowuupsf�injjg RA3��§§.3 procedures (CFM) /!/ 'L- /f.�J :T R}_.L G -N Passes if measured airflow`is greater than or equal"', '} to the calculated minimum airflow requirement. ``' , En`ter Pass or Fail Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for fixed orifice metering device systems System Name or Identification/Tag Calculate: Actual Superheat = Tsuction - Tevaporator, sat Target Superheat from Table RA3.2-2 using Treturn, wb and Tcondenser, db Calculate difference: Actual Superheat - Target Superheat = System passes if difference is between -6°F and +6°F Enter Pass or Fail i Reg: 211-A0057107A-M2500001A-M25A Registration Date/Time: 2011/12/02 18:37:45 HERS Provider: CalCERTS, Inc. 200.8 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-411-MECH-25 Refrigerant. Charge Verification - Standard Measurement Procedure (Page 4 of 5) Site Address: Enforcement Agency: Permit Number: 78292 CALLE LAS RAMBLAS, La Quinta CA 92253 City of La Quinta 11-1201 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 °ti;' ; � � ,� -4°F and +40F � `":.dl 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/Taa�, Calculate: Actual Superheat = I Tsuction - Tevaporator, sat . -. Enter allowable superheat range from manufacturer's specifications (or use range between 30F and 260F if manufacturer's specification is not available) •;_ _ System passes If actual', superheat allowable superheat range �'..' • �' '� °ti;' ; � � ,� ,� !`Enter` Passor Fail � `":.dl , Reg: 211-A0057107A-M2500001A-M25A Registration Date/Time: 2011/12/02 18:37:45 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: 78292 CALLE LAS RAMBLAS, La Quinta CA 92253 City of La Quinta 11-1201 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 Danielle Garcia 1686310 HERS Provider Data Registry Information Sample Group # (if applicable): 258029 System meets all refrigerant charge and airflow not-tested/verified dwelling in la HERS sample group requirements. HERS Rater Company Name: Energy Driven Solutions, Inc. Responsible Rater's Name: Responsible Rater's Signature: Enter Pass or Fail David Bricker Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 11/30/2011 CC2004131 kMp, y.f 6: �• fF C', _ 4. . r•.a n ..:� ,,.,cv:..,. � ...i c Fl. DECLARATION STATEMENT I,,. • 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 -6R) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) HARRISON ENTERPRISES INC Responsible Person's Name: CSLB License: Danielle Garcia 1686310 HERS Provider Data Registry Information Sample Group # (if applicable): 258029 ❑ tested/verified dwelling not-tested/verified dwelling in la HERS sample group HERS Rater Information CaICERTS Certificate # CCI -1798604826 HERS Rater Company Name: Energy Driven Solutions, Inc. Responsible Rater's Name: Responsible Rater's Signature: David Bricker David Bricker Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 11/30/2011 CC2004131 Reg: 211-A0057107A-M2500001A-M25A Registration Date/Time: 2011/12/02 18:37:45 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 1 of 2) Site Address: ❑ 3. Reduce leakage by 60% and conduct smoke and fix all leaks 78292 CALLE LAS RAMBLAS, La Quinta CA 92253 (System Enforcement Agency: Permit Number: 1) City of La Quinta 11 -1201 Enter the Duct System Name or Identification/Tag: Enter the Duct System Location or Area Served: 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 - - ❑ 2. Measured leakage to outside less than 10% of Fan Flow ❑ 3. Reduce leakage by 60% and conduct smoke and fix all leaks 1714. Fix all accessible leaks using smoke and HERS rater verify Note: (One of Optionsj, 2, or 3 must be.attempted,before,utilizing Option,;,4.),, Determine porriinal Fan°Flow using one ofithe following6three,calculation methods:,�f . ' " f ✓ ❑ Cooling system method: Size in Tons_ 400 = CFM �ofS�condenser ,x ✓ El Heating system method: 21 7 x Output Capacity in�Thousands of Btu/hr = "CFM ✓ t Ili... F - �-" y:93;; ❑ Measured,s stem airflow using RA3.3 airflowtest rocedures: _ CFM _ Option i used then:` 1 Allowed leakage = Fan Flow x 0.15 _ CFM ActluaLeakage'- CFM _ ., Pass if Leakage Actual is less than Allowed Pass Lj Fail Option 2 used then:,. ¢ 2 Allowed leakage = Fan Flow x 0.10 = _CFM Actual Leakage to outside,.= t. r' CFM Pass if Leakage Actual is less than Allowed n 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% = a/o 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 9 PN Reg: 211-A0057109A-M2100001A-M21A Registration Date/Time: 2011/12/02 18:35:24 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: 78292 CALLE LAS RAMBLAS, La Quinta CA 92253 (System Enforcement Agency: Permit Number: 1) City of La Quinta 11-1201 ❑ Outside air (OA) ducts for C astral 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 registerboots°must be)sealed to the drywall if,,smoke •test is utilized for�.compliance - appliesito duct leakage compliance option 3 (leakage reduction by 60%) and option 43 (fix "all accessible leaks) described abovveyjfJt O New duct installations -!:cannot utilize building cavities asplenums or.platform.returns'in lieu of'ducts j 4 O Mastic and draw`bands'must be used.in combination with backed`rubber adhesive duct tape to seal leaks at all new duct connection§:"' DECLARATION STATEMENTj1i" • 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- • 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 -1R) 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) HARRISON ENTERPRISES INC Responsible Person's Name: CSLB License: Danielle Garcia 686310 HERS Provider Data Registry Information Sample Group # (if applicable): 2SS029 ❑ tested/verified dwelling not-tested/verified dwelling in la HERS sample group HERS Rater Information CalCERTS Certificate # CC1-1798604828 HERS Rater Company Name: Energy Driven Solutions, Inc. Responsible Rater's Name: Responsible Rater's Signature: David Bricker David Bricker Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 11/30/2011 CC2004131 Reg: 211-A0057109A-M2100001A-M21A Registration Date/Time: 2011/12/02 18:35:24 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 5) Site Address: Enforcement Agency: Permit Number: 78292 CALLE LAS RAMBLAS, La Quinta CA 92253 City of La Quint, 11-1201 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 SupDly and Return Plenums of Air Handler System Name or Identification/Tag w � b; 1 System Location or Area Served ❑.Yes 1.._ ._ ❑_Y,es—.,. _. �❑-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 E)Yes ElNo tK, 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 t o -II and 2 is a pass. ;, Enter Pass or Fail ✓ ❑ Pass ✓ ❑ Fail STMS - Sensoronithe. Evaporator Coil System Name 6r,Identifiication/Tag",)'1,4i.,,,e w � b; 1 3 ❑.Yes 8, The sensor is factory' installed, orlifield'installed'accordind to'manufacturer's sp•eciflcations, or is$installed;by methods/specifications approved by -the Executive ❑Yes kt s~� Director... 4 E] Yes,$ f^'y'} Y� , p,,No� The sensor wire, is term inated.with,a standard mini plug suitable for connectionto a,: digitalthermometer.4,,�The sensor mini.plugiis•accessible to ttie,installmg;;techmcian� The sensor wire is terminated with a standard mini plug suitable for connection to a andtKie HERS.rater:without cFianging the airflow through the condenser coil 5 s , E) No )' When attached to a digital thermometer, the sensor provides an indication of the - I 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, Eail ✓ ❑ 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 . ✓ © N/A ✓ ❑ Pass ✓ ❑ Fail applicable. Otherwise enter Pass or Fail 2 Reg: 211-A0057109A-M2500001A-M25A Registration Date/Time: 2011/12/02 18:37:46 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) Site Address: Enforcement Agency: Permit Number: 78292 CALLE LAS RAMBLAS, La Quinta CA 92253 City of La Quinta 11-1201 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 SS°F or below, the installer must use the Alternate Charge Measurement Procedure. Space Conditioning Systems System Name or Identification/Tag _-: ..` y (must be re -calibrated monthly) j "G._ r+r+'r'r Tt ' ..•-•-rs System Location or Area Served Date of ermocouple .Calibration /fi, ' ,5� ' _((must be re -calibrated monthly) � f Outdoor Unit Serial # Outdoor Unit Make Outdoor Unit Model Nomitiat Cooiing.Capdcity'Btu/fir Date of Verification a.anuracwn yr vIagnusUc ansiruments Date of Refrigerant Gauge Calibratiori6, _-: ..` y (must be re -calibrated monthly) j "G._ r+r+'r'r Tt ' ..•-•-rs . _Ali Date of ermocouple .Calibration /fi, ' ,5� ' _((must be re -calibrated monthly) � f ^ i' rIT j . - F r System Name or Identification/Tag-t r,+ ' o _-: ..` y r , j j "G._ r+r+'r'r Tt ' ..•-•-rs . _Ali Supply (evaporator leaving):air,.dry bulb temperature (Tsupply, db) Return (evaporator entering) air dry' -bulb tempeeafure•(Treturn, db) #y d: Return (evaporator entering) air wet -bulb temperature (Treturn, wb)' 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: 211-A0057109A-M2500001A-M25A Registration Date/Time: 2011/12/02 18:37:46 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: Enforcement Agency: Permit Number: 78292 CALLE LAS RAMBLAS, La Quinta CA 92253 City of La Quinta 11-1201 Minimum Airflow Reauirement 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, w b a n d 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 N4te;Jemp.exg.4ceSe(itMethod Calculation is.not.nP(:essary.if.ar..tijal re)D-1n4 r"odAi;-#lo_misyerified using one of the _isflow measureme"r,-t-rrocedurassp€<if•.ao :^-Rcfere:.c4e Residential Appendix RA3.3. If acLa! cooling coil air,'[ -,w 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) a.- System Namee or Iderit fication/Tag 1 I rCWZZp �I P.++' 7V -er� 7---& x Calculated Minimum Airflow,Requirement (CFM) .� .. `. •fp r+ ^ p.' e� 7e Measured, Airflow usingRA3:3 rocedures CFM ,/t''k qX. ,' -- t _. SL Passes if measured airflow is greaterthan;or.equal to the calculated minimum airflow requirement: , r r Enter Pass or Fail Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for fixed orifice metering device systems System Name or Identification/Tag Calculate: Actual Superheat = Tsuction - Tevaporator, sat Target Superheat from Table RA3.2-2 using Treturn, wb and Tcondenser, db Calculate difference: Actual Superheat - Target Superheat = System passes if difference is between -6°F and +6°F Enter Pass or Fail Um Reg: 211-A0057109A-M2500001A-M25A Registration Date/Time: 2011/12/02 18:37:46 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-411-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5) Site Address: Enforcement Agency: Permit Number: 78292 CALLE LAS RAMBLAS, La Quinta CA 92253 City of La Quinta 11-1201 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 17, 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 ', s. � ti �f �,.• ,�,, Enter Pass or Fail Metering Device Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. Sv_srrgeNamg gd Wen-kifcation/Tag 17, Calculate: Actual Superheat = 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 passesrif.actual',superheat is"within°theft; range ', s. � ti �f �,.• ,�,, allowablsuperheat Enter: Pass or Fail Reg: 211-A0057109A-M2500001A-M25A Registration Date/Time: 2011/12/02 18:37:46 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: 78292 CALLE LAS RAMBLAS, La Quinta CA 92253 City of La Quinta 11-1201 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 Danielle Garcia 686310 HERS Provider Data Registry Information Sample Group # (if applicable): 258029 System meets all refrigerant charge and airflow 0 not-tested/verified dwelling in la HERS sample group requirements. HERS Rater Company Name: Energy Driven Solutions, Inc. Responsible Rater's Name: Responsible Rater's Signature: Enter Pass or Fail David Bricker Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 11/30/2011 CC2004131 , 7vi- DECLARATIONF STATEMENT) • I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. • I am the certified HERS rater who performed the verification services identified and reported on this certificate (responsible rater). . The installed feature, material, component, or manufactured device requiring HERS verification that is identified on this certificate (the installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified on the Certificate(s) of Compliance (CF -111) approved by the local enforcement agency. • The information reported on applicable sections of the Installation Certificate(s) (CF -6R), signed and submitted by the person(s) responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -111) approved by the enforcement agency. Builder or Installer information as shown on the Installation Certificate (CF -6111) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) HARRISON ENTERPRISES INC Responsible Person's Name: CSLB License: Danielle Garcia 686310 HERS Provider Data Registry Information Sample Group # (if applicable): 258029 ❑ tested/verified dwelling 0 not-tested/verified dwelling in la HERS sample group HERS Rater Information Ca10ERTS Certificate # CC1-1798604828 HERS Rater Company Name: Energy Driven Solutions, Inc. Responsible Rater's Name: Responsible Rater's Signature: David Bricker David Bricker Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 11/30/2011 CC2004131 Reg: 211-A0057109A-M2500001A-M25A Registration Date/Time: 2011/12/02 18:37:46 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS Duct Leakage Test — Existing Duct System (Page 1 of 2) Site Address: 78292 CALLE LAS RAMBLAS, La Quinta CA 92253 (System Enforcement Agency: Permit Number: City of La Quinta 11-1201 Enter the Duct System Name or Identification/Tag: System 1 Enter the Duct System Location or Area Served: Bedrooms 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 0 2. Measured leakage to outsidelegs'than 10%" of Fan Prow" conduct ❑ 3. Reduce leakage by 60% and smoke and fix all leaks smoke ❑ 4: Fix all accessible leaks using and HERS rater verify Note: (One of Options 1, 2 or 3 musfbe,attempted: before utilizing Option 4,)_ Determine �nominal.F ari Flow using `one of -the following three' calculation methods . ; G1 101 : ` e.� ld t ✓ Cooling system method: Size df condenser in Tons +l x`400 = 1200 ii ✓ ❑ Heating system method: 21 7 xOutput Capacity in Thousands of Btu/hr = _ CFM x ./[]Measured airflow procedur s: a' } s RM system airflow using _RA3.3 test CFM ;;,1 r , '� / Optiona used -then:- � '_ t ^L ,•. ;K>: 1 Allowed leakage = Fan Airflow 1200" x 0.15 - 180 . CFM Actual Leakage =`85 CFM Pass if Actual Leakage is less than Allowed leakage p Pass 0 Fail Option 2 used then:. 2 Allowed leakage = Fen'Airflow x 0.10 = _ CFM Actual Leakage to outside,=_F CFM Pass if Actual leakage to outside is less than Allowed leakage M Pass Fail Option 3 used then: Initial leakage prior to start of work = _ CFM Final leakage after sealing all accessible leaks using smoke test = CFM 3 Initial leakage _ - Final leakage _ = Leakage reduction CFM ((Leakage reduction _ / Initial leakage___) x 100% _ % Reduction Pass if % Reduction > 60% M Pass Fail Option 4 used then: 4 All accessible leaks repaired using smoke test. HERS rater must verify (No Sampling). Pass if all accessible leaks have been repaired using smoke Ej Pass Fail Reg: 211-A0057109A-M2100001A-0000 Registration Date/Time: 2011/11/30 20:51:17 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: Danielle Garcia CSLB License: 686310 78292 CALLE LAS RAMBLAS, La Quinta CA 92253 (System Enforcement Agency: Permit Number: 1) City of La Quinta 11-1201 10 Outside air (OA) ducts for C astral 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' s e�s&'a!_5 to the drywall if smoke test'"is, utilized for compliance - applies�to'duct leakage compliance option 3 (leakage reduction by 60%) and option 4`(fix".all accessible leaks) described above. 0 New lduct installations cannot>utilize.building cavities as plenum!Aor platform4returns in lieu of ducts ; !.+ F Y,. '''� 1 ,yw'.7 „•.> ✓ ,.A'46.e..H µ F�'+. © Mastic and draw bands^must':be used"in,combination_with,cloKba6k d rru-b4ber adhesive'duct'tape to seal leaks at all new duct connections ,�;.'`r ' t.> DECLARATION STATEMENT • I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. • I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized representative of the person responsible for construction (responsible person). • I certify that the installed features, materials, components, or manufactured devices identified on this certificate (the installation) conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the enforcement agency. . I understand that a HERS rater will check the installation to verify compliance, and that that if such checking identifies defects, I am required to take corrective action at my expense. I understand that Energy Commission and HERS provider representatives will also perform quality assurance checking of installations, including those approved as part of a sample group but not checked by a HERS rater, and if those installations fail to meet the requirements of such quality assurance checking, the required corrective action and additional checking/testing of other installations in that HERS sample group will be performed at my expense. • I reviewed a copy of the Certificate of Compliance (CF -1R) form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF -1R that apply to the installation have been met. • I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. I will ensure that all Installation Certificates will come from a HERS provider data 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) HARRISON ENTERPRISES INC Responsible Person's Name: Responsible Person's Signature: Danielle Garcia Danielle Garcia CSLB License: 686310 Date Signed: 11/5/2011 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-A0057109A-M2300003A-0000 2008 Residential Compliance Forms Registration Date/Time: 2011/11/30 20:51:17 HERS Provider: CalCERTS, Inc. March 2010 INSTALLATION CERTIFICATE* CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 5) Site Address: Enforcement Agency: Permit Number: 78292 CALLE LAS RAMBLAS, La Quinta CA 92253 City of La Quinta 11-1201 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 Suooly and Return Plenums of sir Manellar System Name or Identification/Tag System 1 System Location or Area Served Bed 1. _ IJI Yes _, ❑ No _ -- 5/16 inch (8 mm) access hole upstream of evaporative coil in the return plenum and labeled according,to Figure in Section - 3:2.2.2.2. -- — -- 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. V Enter Pass or Faill ✓ 2 Pass ✓ ❑ Fail STMS - Sensor on -the Evaporator -Coil System Name -or Identification/Ta ,&k; 3 s�. ❑ Yes - The sensor is factory installed; or field installed'according to manufacturer s ®.No , specifications, or isiinstalled,by methods/specifications`approved b`ythe Executive The sensor is factory installed, or field installed according to manufacturer's 6 Director.. 4 : ❑ Yes.ie%rs �f `The sensor wire is terminated with,a standardimini plug suitable for connection 19,_884 p No digital thermometer. The sensor mini'plug is.acces§ible to the installingf�technican"" and,the HERS rater'without changing the airflow..through the condenser coil` 5 ❑ Yes ❑ No ! The sensor measures the saturation temperature of the coil within 1.3 degrees F Yes to,3jA, and 5 is a•pass. Enter N/A if STMS are not applicable. Otherwise enter Pass orFail ✓ p N/A ✓ ❑ Pass ✓ ❑ Fail STMS - Sensor on the Condenser Coil System Name or Identification/Tag System 1 The sensor is factory installed, or field installed according to manufacturer's 6 ❑ Yes ❑ No specifications, or is installed by methods/specifications approved by the Executive Director. The sensor wire is terminated with a standard mini plug suitable for connection to a 7 ❑ Yes ❑ No digital thermometer. The sensor mini plug is accessible to the installing technician and the HERS rater without changing the airflow through the condenser coil 8 ❑ Yes ❑ No IThe sensor measures the saturation temperature of the coil within 13 degrees F Yes tc 6, 7, and 8 is a pass. Enter N/A if STMS are not ✓ p N/A ✓ ❑ Pass ✓ El Fail applicable. Otherwise enter Pass or Fail a Reg: 211-A0057109A-M2500001A-0000 Registration Date/Time: 2011/11/30 20:53:17 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-25-HER: tefrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5 Site Address: Enforcement Agency: Permit Number: 78292 CALLE LAS RAMBLAS, La Quinta CA 92253 City of La Quinta 11-1201 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 Conditionino Svstems System Name or Identification/Tag System 1 (must be re -calibrated monthly) .. System Location or Area Served Bed 10-8-i'1! (most be re -calibrated monthly) X " jr e�'+ Outdoor Unit Serial # 1911HISISS Outdoor Unit Make Lennox Outdoor Unit Model 14ACX-036-230 p._ lrdominail 'Cooling -Ca acitY Bta`j'r. 54 Date of Verification 11-5-11 %.cln N142l.IV11 u► V14911ubHG L"bLrume"Eb Date of Refrigerant Gauge Calibration 10-8-11 (must be re -calibrated monthly) .. Supply (evaporator leaving) air dry=bulb `j Date of Thermocouple Calibrationr r�/�74 10-8-i'1! (most be re -calibrated monthly) X " jr e�'+ temperature supply, db) ,. ricaJurcu I.CmpCrdLufCSNa r•),e.■�iJ w..•`9.. r i ..'!'. f .. 7 System Name or Id�e/n♦tification/Tagg System i' �'�"{ jJy ' .. Supply (evaporator leaving) air dry=bulb `j 49 Wit. k _- temperature supply, db) ,. Return (evaporator -entering) air dry-bulb 70 temperature (Treturn,'db) I Return (evaporator entering) air wet -bulb 54 temperature (Treturn, wb) '., Evaporator saturation temperature 38.9 (Tevaporator, sat) Condensor saturation temperature 79.5 (Tcondensor, sat) Suction line temperature (Tsuction) 54.1 Liquid Line Temperature (Tliquid) 68.4 Condenser (entering) air dry-bulb 63 temperature (Tcondenser, db) 1 I Reg: 211-A0057109A-M2500001A-0000 Registration Date/Time: 2011/11/30 20:53:17 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5) Site Address: Enforcement Agency: Permit Number: 78292 CALLE LAS RAMBLAS, La Quinta CA 92253 City of La Quinta 11-1201 Minimum Airflow Requirement Temperature Split Method Calculations for determining Minimum Airflow Requirement for Refrigerant Charge Verification. The temperature split method is specified in Reference Residential Appendix RA3.2. System Name or Identification/Tag System 1 Calculate: Actual Temperature Split = Treturn, 21.00 db - Tsupply, db Target Temperature Split from Table RA3.2-3 20 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 Fail Note:.T,amp�rafure.Sp�Lt lethod„Cal�ulatian is not necessary_ ff_actual._G9olino Cjj�lidfloy i5--.ye_if(ed..uSJng.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 ) =Nominal Cooling Capacity (ton) X 300 (dm/ton) q ( CFM System Name o Identification/Tag” w.. Syst m 1 it , ll Calculated Minimum Airflow RVequirement (CFM) Measured Airflow,using RA3.3 procedures (CFM-) Yam 't. 4-�� .+ Y�� t•� �' ��?p`�' wer.�_".'-»�..+. _ 3- � ,mak• j 4.1 Passes if measured airflow is greaterthan or- r equal equal to the calculated minimum airflow requirement -';<:"r„ - P", 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 f 0 Reg: 211-A0057109A-M2500001A-0000 Registration Date/Time: 2011/11/30 20:53:17 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5) Site Address: FEorcement Agency: Permit Number: 78292 CALLE LAS RAMBLAS, La Quinta CA 92253 y of La Quinta 11-1201 Subcooling Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag System i Calculate: Actual Subcooling 15.2 Tcondenser, sat - Tliquid Target Subcooling specified by manufacturer 13 Calculate difference: -1.9 Actual Subcooling - Target Subcooling = System passes if difference is between -3°F and +3°F PASS rte. 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 =- 15.2 Tsuction - Tevaporator, sat j', -. Enter allowable superheat range from manufacturer's specifications (or use'range 25 between 4°F and 25°F if manufacturer's specification is not available) j System passes if'actuaP superheat is,withinvthe allowable superheat range ,.t .. =_ i f PASS rte. s Pass or,Fail ,,.,,Enter Reg: 211-A0057109A-M2500001A-0000 Registration Date/Time: 2011/11/30 20:53:17 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: 78292 CALLE LAS RAMBLAS, La Quinta CA 92253 City of La Quints 11-1201 Standard Charge Measurement Summary: System shall pass both refrigerant charge criteria, metering device criteria (if applicable), and minimum cooling coil airflow criteria based on measurements taken concurrently during system operation. If corrective actions were taken, all applicable verification criteria must be re -measured and/or recalculated. System Name or Identification/Tag System 1 CSLB License: 686310 Date Signed: 11/5/2011 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 r � r " 7�1 .v r 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 -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) HARRISON ENTERPRISES INC Responsible Person's Name: Responsible Person's Signature: Danielle Garcia Danielle Garcia CSLB License: 686310 Date Signed: 11/5/2011 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-A0057109A-M2500001A-0000 Registration Date/Time: 2011/11/30 20:53:17 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS Duct Leakage Test — Existing Duct System (Page 1 of 2) Site Address: 3. Reduce leakage by 60% conduct 78292 CALLE LAS RAMBLAS, La Quinta CA 92253 (System Enforcement Agency: Permit Number: 1) City of La Quinta 11-1201 Enter the Duct System Name or Identification/Tag: System 2 Enter the Duct System Location or Area Served: Living 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. R 1. Measured leakage less than 15% of fan flow 2. Measured lea�fcage to oukside less than 10%of Fan Ffow 3. Reduce leakage by 60% conduct ❑ and 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, Opt ion 4..). Determine nominal Fan`.Flow using one` of -the following'three calculation methods. .� ` CFM ✓ E5 Cooling system method: Size o condenser in Tons 13.5"- x 400 k 1400 ✓ ❑ Heating method': 21.1 Output C�apa in Thousan}ds of Btu/hr = � CFM nx _ 'A_ {{system rydty C i E`i .' ! i J r• j • ,� ".r fs'�.-jJ}—e''..�"y�tgj ,/f ❑ Measured system airflow using RA3.3 airflow.ktest procedures CFM # _ _ ,. Option 4.used thenar . }e, _ 1 Allowed leakage = Fan Airflowl 14001" x 0.15 210 CFM Actual Leakage -=__A6 CFM; { Pass if Actual Leakage is less than Allowed leakage p Pass Fail Option 2 used then:,, 2 Allowed leakage = Fan 'Airflow x 0.10 = _ CFM Actual Leakage to outside.,= f" CFM >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 > 60% Pass Fail Option 4 used then: 4 All accessible leaks repaired using smoke test. HERS rater must verify (No Sampling). Pass if all accessible leaks have been repaired using smoke El Pass R Fail Reg: 211-A0057107A-M2100001A-0000 Registration Date/Time: 2011/11/30 20:56:20 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: Danielle Garcia CSLB License: 686310 78292 CALLE LAS RAMBLAS, La Quinta CA 92253 (System Enforcement Agency: Permit Number: 1) City of La Quinta 11-1201 ,. - E5 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. E5 All supply and return register boots+must-beisea ped to -the drywall. if smoke test is utilized for compliance - applieslto,duct leakage compliance option 3 (leakage,reductlon by''60%) and option,41(fix alli a cessible leaks) described above. 0 New ducttinstallatlons,cannot.utilize building cavities asplenums)or platform returns in lieu of diuctrs, , LO ® Mastic 6nd_draw1bandsmust;be used'in,combination,with°cloth backed rubber'adhesive duct tape to seal leaks at all new duct connection's,,:" " 17 DECLARATION STATEMENT • I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. • I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized representative of the person responsible for construction (responsible person). • I certify that the installed features, materials, components, or manufactured devices identified on this certificate (the installation) conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the enforcement agency. • I understand that a HERS rater will check the installation to verify compliance, and that that if such checking identifies defects, I am required to take corrective action at my expense. I understand that Energy Commission and HERS provider representatives will also perform quality assurance checking of installations, including those approved as part of a sample group but not checked by a HERS rater, and if those installations fail to meet the requirements of such quality assurance checking, the required corrective action and additional checking/testing of other installations in that HERS sample group will be performed at my expense. • I reviewed a copy of the Certificate of Compliance (CF -1R) form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF -111 that apply to the installation have been met. • I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. I will ensure that all Installation Certificates will come from a HERS provider data 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) HARRISON ENTERPRISES INC Responsible Person's Name: Responsible Person's Signature: Danielle Garcia Danielle Garcia CSLB License: 686310 Date Signed: 11/5/2011 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-A0057107A-M2100001A-0000 Registration Date/Time: 2011/11/30 20:56:20 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE* CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 5) Site Address: Enforcement Agency: Permit Number: 78292 CALLE LAS RAMBLAS, La Quinta CA 92253 City of La Quint 11-1201 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 SIMS 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 Suoolv and Return Plenums of Air Handler System Name or Identification/Tag System 2 System Location or Area Served Living 1 9Yes.._,..- D No.5/16 " inch (8 mm) access hole upstream of evaporative coil in the return plenum and iabeled acc:ordiny`to Figure in Section RA3.2.2.2:17 2� p Yes ❑ No q 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. j"I Enter Pass or Faill ✓ El Pass ✓ ❑ Fail STMS - Sensor on -the Evaporator Coil �. System Name or. Identification/Tag "j (.,,. �✓,.� ^.'System 2 -+-11 3 ,._ '❑,Yes K'01A The sensor is factory installed,'orfield installed according to manufacturers tions, or islinstalled by methods/specifications approved by,the Executive - ❑ Yes ' =414Director. specifications, or is installed by methods/specifications approved by the Executive l� . ■J yi "" 4 4 ❑.Yes ' it : `❑ No The sensor wire is terminated�with,a standard'tnmi plug suitable for connection-toa -' digital thermometer. The sensor mini plug is accessible to the..installing. technician, ``x w. � •_ '�,.. �At ; ,and the HERS'�atei .witfiout.changing the airflow through the condenser coil' 5 ❑ Yes ❑ No PIThe sensor measures the saturation temperature of the coil within 1.3 degrees F ,3;,4, and 5 is a; pass. Enter N/A if STMS are not --F✓ rapplicable: Otherwise enter Pass orjFail p N/A ✓ C-] Pass ✓ ❑Fail STMS - Sensor on the Condens erCoil System Name or Identification/Tag I 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 The sensor measures the saturation temperature of the coil within 1.3 degrees F Yes to 6, 7, and 8 is a pass. Enter N/A if STMS are not ,/ p N/A ✓ C] Pass ✓ ❑Fail applicable. Otherwise enter Pass or Fail Reg: 211-A0057107A-M2500001A-0000 Registration Date/Time: 2011/11/30 20:58:15 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-25-HER: tefrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5 Site Address: Enforcement Agency: Permit Number: 78292 CALLE LAS RAMBLAS, La Quinta CA 92253 City of La Quinta 11-1201 Standard Charge Measurement Procedure (for use if outdoor air dry-bulb is above 55°F) Procedures for determining Refrigerant Charge using the Standard Charge Measurement Procedure are available in Reference Residential Appendix RA3.2. As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional form(s) for any additional systems in the dwelling as applicable. • The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure. • The system must meet minimum airflow requirements as prerequisite for a valid refrigerant charge test. • If outdoor air dry-bulb is 55°F or below, the installer must use the Alternate Charge Measurement Procedure. Space Conditioning Systems System Name or Identification/Tag System 2 (must be re -calibrated monthly) ta_ c System Location or Area Served Living R,.,i�'-'�'a _ fi 10=8-11 �; ""...'7 '"""'•'A �A` 'S (must be -calibrated monthly) Outdoor Unit Serial # 191OD18995 K , Outdoor Unit Make Lennox Outdoor Unit Model 14ACX-041-230 Return (evaporator entering) air wet=bulb 4.'500 _. _.. _ _. ._. _ _.•. _ .._ _ .. Date of Verification 11-5-11 ra11Y-PUY-- YI V-pa_J-IVDLIG LIMILUumC'nLs Date of Refrigerant Gauge Calibration 10-8-11 (must be re -calibrated monthly) ta_ c /fes'.}' d Date of Tlh rmocouple;Calibration R,.,i�'-'�'a _ fi 10=8-11 �; ""...'7 '"""'•'A �A` 'S (must be -calibrated monthly) Supply (evaporator leaving) -air dry-bulb', p " temperature (Tsupply, db),. red ' --I/G- Y FYI c.�-•\w ■- / 4. Y -. S, 'rHs51 R a i ..... 1 A System Name or Identification/Tag's System 2 � �,. � �-�-�r~'�`"`� c _ Supply (evaporator leaving) -air dry-bulb', p " temperature (Tsupply, db),. 51 4.r_` K , Return (evaporator -entering) air dry-bulb 70 temperature (Treturn db.) Return (evaporator entering) air wet=bulb 56 temperature (Treturn, wb) , t -' Evaporator saturation temperature 43.7 (Tevaporator, sat) Condensor saturation temperature 79.4 (Tcondensor, sat) Suction line temperature (Tsuction) 57 Liquid Line Temperature (Tliquid) 70 Condenser (entering) air dry-bulb 63 temperature (Tcondenser, db) Reg: 211-A0057107A-M2500001A-0000 Registration Date/Time: 2011/11/30 20:58:15 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5) Site Address: Enforcement Agen7711-1201 Permit Number: 78292 CALLE LAS RAMBLAS, La Quinta CA 92253 City of La Quinta 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, db - Tsupply, db 18.60 Target Temperature Split'from Table RA3.2-3 using Treturn, wb and Treturn, db 19.3 Calculate difference: Actual Temperature Split - _0 Target Temperature Split = Passes if difference is between -3°F and +3°F or, upon remeasurement, if between -3°F and PASS -100°F Enter Pass or Fail j(e:; Te[nperatu�e:Sp1i.NeEdlcul��tion i3,iiot �G�sa.,ry j%.dctual �9Qling'Coi! Airfow_LS ver(f1�d u_s�nc�oilef lie. �_, 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 ty (ton) X 300 (cfm/ton) t System Name or;Identification/Tag =tt �!`,�r ; : - ' System Z S ,. Calculated Minimum Airflow Requirement (CFM) 1 € l X, FMeasured MeasuredAirflow,us ng RA3.3 procedures (CFM)+ Passes if measured airflow is greaterthan or,�- equal to the calculated minimum airflow requirement:'" "k. • 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 Fail 1140 Reg: 211-A0057107A-M2500001A-0000 Registration Date/Time: 2011/11/30 20:58:15 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-611-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5) Site Address: Enforcement Agency: Permit Number: 78292 CALLE LAS RAMBLAS, La Quinta CA 92253 City of La Quinta 11-1201 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 = 13.3 Tcondenser, sat - Tliquid 9 4 Target Subcooling specified by manufacturer 9 Calculate difference: 0.4 Actual Subcooling - Target Subcooling = System passes if difference is between -3°F and +3°F PASS 3 S Enter Pass or Fail Metering Device Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag —� System 2 Calculate: Actual Superheat =_ 13.3 Tsuction - Tevaporator, sat Enter allowable superheat range from manufacturer's specifications (or use range 25 between 4°F and 25°F if manufacturer's specification is not available) System passes if; actual',superheat is, ithin,the < allowable superheat range' PASS' 3 S f,, Enter Pass or Fail % •'l., A + A a i f n + F Reg: 211-A0057107A-M2500001A-0000 Registration Date/Time: 2011/11/30 20:58:15 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-611-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5) Site Address: Enforcement Agency: Permit Number: 78292 CALLE LAS RAMBLAS, La Quinta CA 92253 City of La Quinta 11-1201 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 CSLB License: 686310 Date Signed: 11/5/2011 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 Ita. a If 1 flyyyy �[ r j ,--'"" - ..r � . �. .�� _ ,- ,...�:'" .. ,.,. r= ' , •- ` ,.. '� .:tet < . ir p. 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 -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) HARRISON ENTERPRISES INC Responsible Person's Name: Responsible Person's Signature: Danielle Garcia Danielle Garcia CSLB License: 686310 Date Signed: 11/5/2011 Position With Company (Title): Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? ❑ Yes ❑ No IN Reg: 211-A0057107A-M2500001A-0000 Registration Date/Time: 2011/11/30 20:58:15 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 SMOKE AND CARBON MONOXIDE /ALARM RETROFIT VERIFICATION 1.7 -bb U T6 17�6 and I, (Prifit Property Owner's Name) who own and/or live in the dwelling located at: , (Tenant's Name - if same as Owner write "Same") (Add verify that the smoke and carbon monoxide alarms required by the California Residential Code (CRC) have been installed in the dwelling, incompliance with the code and with the manufacturer's instructions and further -that-they have been tested -and -do function -properly: In an effort to enhance life safety within dwellings, CRC Section R314.6, R315:2 and CBC 420.4 require the retrofit of these alarms in existing dwellings when alterations, repairs or additions requiring a permit and exceeding $1,000 in value are made. Generally, the alarms must be hard wired (110 volt) with battery back-up and all alarms are to be interconnected. if the installation of the alarms will require the removal of wall or ceiling finishes or there is no access by means of attic, basement or crawl space, then alarms may be solely battery operated and not interconnected. Alarms must be installed in all of the following locations within the existing dwelling: ➢ In all bedrooms (only require Smoke Alarms) ➢ Immediately outside of :each separate bedroom. (require Smoke and Carbon Monoxide Alarms) ➢ In each story level of the dwelling, including basements and habitable attic rooms (require Smoke and Carbon Monoxide Alarms) These safety devices must be installed by the time a final inspection is requested for your project I understand the above requirements and certify that we now have smoke alarms and carbon monoxide alarms installed that comply. We agree to comply with the CRC. in regards to. smoke alarms, carbon . monoxide alarms. Signature of Owner Date Signature of Tenant Date ATTENTION OWNER- OCCUPANT: This is a Voluntary Smoke and Carbon Monoxide Alarm verification procedure. If you prefer a Building Inspector to perform the verification, you must arrange to have an adult present at the time of inspection. NOTE. This Verification is only used when normal access to the interior of the dwelling by the City'of : uilding Inspector is not achieved during the course of project construction. It is normally used for projects such as re-roorrng, re -siding, patio covers, swimming pools and the like. -Z� —/9-O� S? 1 o ? i�- 4-005 -7 /oq- HVAC Field Data Sheet Pg 1 oft Client Named we,l c DM � ATO Job # Date 11 15 I ea-fil I Address` -1T aq_ 3 Ph # Technicians) Permit # C Gauge/Thermocouple Calibration Date 1 SpH I Package j Some Ducts Only I All Ducts Only (Circle type of work) 6MECA-04 , F..: metntData ZOA(E 1 XON s 2 ZONE3 ZONE4 System Location or Area Served SZkQW f -S 4 " eA Heating Equipment Make uta ® X L,6113 Heating Equipment Model ARI Reference Number Lag n 5a Duct Location (attic, crawlspace, etc.) N1 CL Y Duct R Value (if ducts were installed) L7 - aHeating Heating Load Heating Equipment Output Capacity Condenser Make - N D Condenser Model cat✓ os6- 1`-± = Size in Tons 3 v� ° -0-4 SEER & EER I o.0v is -UO IV Com' Cooling Load3L-27- J L4 2 11 Cooling Capacity ENI. a,> 4' M Qf-20 & 21 Dud Twing Duct leakage pretest result Dart Leakage FmW Result 4a4aM/coa to pass (646) PasslFag Pampero Pa%IFA PassIrw Duct Leakage Final Res& e60 CM/con to pass (1546) Pass using 60% leakage reduction? bait PasslPau "FA Pass using smoke and visual inspection? MECH22.or:1CN26 'Coolht OWAbfiow& Pan:iiVat6Dr+aw . Measured Air Volume from Flow Grid or Hood NEW DUCTS Target 350 CFM/ton a Condenser Tons CHAN(EOUT Target 300 CFM/tion s condenser Tons Measured air greater than Target? (YIN) - Measured Fan Watt Draw Target: OSS watts/measured CFM Measured Watts less than Target? (Y/N) Copyright 0 2011 EDS ts' mV DrIm Sohalmr., bm HVAC Field Data Sheet . Pg 2 of 2 Client Name job # Date MFLN 25 . Char ge & Airflow • ZONE 1 ZONE2 ZONE 3 ZONE 4 Condenser Serial Number Supply air dry bulb temperature Q I 1� l .5l� V3® t M Return air dry bulb temperature Return air wet bulb temperature 0 Evaporator Saturation Temperature Q , U) . Condenser Saturation Temperature , Suction Line Temperature I� Liquid Line Temperature % , D Suction Pressurera PAO Liquid Prey -sure_. Actual Airflow Temperature -Split p Target Temperature Split from Table RA3.2.3 (� Passes if difference is t T of Target Temp (YIN) S Actual Subeooling (t 4° of Target to pass) Target Subcooli ng from Mfr. Actual Superheat (3 to 26° to pass) I LI , U l� Outside air dry bulb temperature JUW 96 "Weigh -/s Charging below 55-. Actual Line Set length (ft) Mfr's Standard Lime Set Length (ft) Length Difference = Correction Factor (ounces per foot) Target Correction Factor x Length Difference System Charged to Target? (YIN) Other Data Minimum amps Maximum amps U— Breaker size "A6 O Compressor amps Return Static Pressure Supply Static Pressure Supply Air Wet Bulb Temperature "ALL APPUQUEBOW ON TMSFORNMUST BECOMPLETED FOR EACRjOR NOEXCEMONS; * « eopyfl& 0 2011 EDS BnaU Drtm Schd[OM tae