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11-1243 (MECH).1;4 a (1 P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: -_11-00001243 Property Address: 50115 EL DORADO DR APN: 777 -280 -004 - Application description: MECHANICAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 16200 Applicant: . I hereby affirm under penalty of pe Section 7000) of Division 3 of the License Class: C20 -C36 ate: nt or: Tiiy/ 4 e(A Q" Architect or Engineer: PIN BUILDING & SAFETY DEPARTMENT BUILDING PERMIT =--------------------------------- LICENSED CONTRACTOR'S DECLARATION at I am licensed under provisions of Chapter 9 (commencing with ;Sand Professionals Code, and my License is in full force and effect. / Aicense No.: 777794 ( OWNER -BUILDER DECLARATION . I hereby affirm under penalty of perju that I am exempt from the Contractor's State License Law for the following reason (Sec. 7031.5, Busin s and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: (_ 1 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). 1 _ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). (_ 1 I am exempt under Sec. , B.&P.C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097., Civ. C.). Lender's Name: Lender's Address: L.QPERMIT Owner: FABER LOIS 50115 EL DORADO DRIVE LA QUINTA, CA 92253 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 11/17/11 Contractor: J ANTHONY PLUMBING HEAT/AIR D) 11 l ' i 72216 NORTH SHORE STREET, #1 A THOUSAND PALMS CA 92276 , N, I rti PALMS, i blS 1 1 t 201' (760) 328-8096 _._._...,J LiC. No.: 777794 CITY OF LA QUINTA ------------------ 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. V11I 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 po' y number are: Carrier STATE FUND Policy.Number 1932451-2011, I certify that, in the perf mance of the wo for which this permit is issued, I shall not employ any person in any manne so as to become ubject to the worker, ' ompensation laws of California, and agree thatA�sould,bsecome su ct to the worker ompe tion provisions of Section //3700 of the Lhl fort ith complyw' those pro s. WARNING: FAILURE TO SECQ$ ORKERS' CON%SMSATION COVERAGE IS UNLAWFUL; AND SHALL ER SUBJECT AN EMPLOYTO CRI INAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. 1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application, the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this rrm . 2. Any permit issued as a result of this applicati becomes null and void if ork is not commenced within 180 days from date of issu nce of s h permit, or cessation of rk for 180 days will subject permit to cancellation. I certify that I have read this application and st a that t e above information is orre I agree to comply with all city and county ordinances and state la g to b Idi construction, a here authorize representatives . of this co my to enter upon the above-mentio ed prop rty r inspection p poses. te: I I I nature (Applicant or genu: Application Number . . . . . 11-00001243- Permit 1-00001243 Permit . . . MECHANICAL Additional desc . Permit Fee . . . . 66.00 Plan Check Fee 16:50 Issue Date . . . . Valuation . . . . 0 Expiration Date 5/15/12 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 REPLACE (2).5 TON SYSTEMS, CONDENSERS, FURNACES & COILS. 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 Compliance: 2008 Residential HVAC Alterations CF -IR -ALT -HVAC Climate Zones 10 - 15 Site Address: Enforcement Agency: Date: Permit #: 50115 EL DORADO DR La Quinta, CA 92253 City of La Quint a Nov 17, 2011 Duct insulation Conditioned Floor Equipment Typel, List Minimum Efficiency2 requirement Area Thermostat ❑ Package Unit p Furnace 2 AFUE 78% ❑ COP E] R 6 (CZ 10-13) Served system M Setback p Indoor Coil p SEER 14.0 E]HSPF El R 8 (CZ 14-15) 1450 Sf If not already present, must be p Condensing Unit E] EER C] Resistance installed) ❑ Other 1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -IR -ALT -HVAC for each system. 2. Minimum Equipment Efficiencies: 13 SEER, 78% AFUE, 7.7HSPF for typical residential systems. HERS VERIFICATION SUMMARY Listed below are FOUR HVAC alteration Options. The installer decides what work is being done and picks one of the appropriate Options. Each Option lists the HERS measures that must be conducted. A copy of the forms shall be left on site for final inspection and a copy given to the homeowner. At final, the inspector verifies that the work listed on this form was in fact the work completed by the installer. The inspector also verifies that each appropriate CF -6R and registered CF -4R forms (no hand filled CF-4Rs allowed) are filled out and signed.Beginning October 1, 2010, a registered copy of the CF -111 and CF -611 shall also be on site for final inspection. D 1. HVAC Changeout Required Forms: . All HVAC Equipment CF -611 forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS replaced CF -4R forms: MECH-21 and (for split systems) MECH-25 • Condenser Coil and /or • Indoor Coil and /or CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS . Furnace CF -4R forms: MECH-21 and (for split systems) MECH-25 For Split Systems: Duct leakage < 15 percent; RC, CCA <_ 300 CFM/ton (Minimum Air Flow Requirement), TMAH Exempted from duct leakage testing if: ❑ 1. Duct system was documented to have been previously sealed and confirmed through HERS verification, or ❑ 2. Duct systems with less than 40 linear feet in unconditioned space, or ❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos 1714. The.,system•will not be Ducted (ie. Ductless Mini -Split -System) -(Also -Exempt from; Refrigerant Charge) ❑ 2. New HVAC System Required Forms: . Cut in[or Changeout with' CF-6R`forms: MECH-04, MECH-20-HERS /and (fog split systems) MECH-22-HERS, and new ducts: (all new ducting and all new MECH-25-HERS CF. form_ MECH 20, MECH-22, MECH-25 equipment) /i{� -4R s: and (for split systems) and �%/ 1 / _ J i i 1` For Split Systems: Duct leakage < 6 percent; RC, CCA >_ 350 CFM/ton, FWD, TMAH, ST MS, and either HSPP or PSPP. " For Packaged Units: Duct leakage < 6 percent ❑ 3. New Ducts with/or without Required Forms: Replacement . Includes replacing or installing all new ducting and/or outdoor condensing unit CF -6R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS and/or indoor coil and/or furnace. No or some CF -4R forms: MECH-20 and (for split systems) MECH-25 equipment changed. For Split Systems: Duct leakage < 6 percent; RC, CCA >_ 300 CFM/ton, TMAH For Packaged Units: Duct leakage < 6 percent 114. New Ducting over 40 feet Required Forms: . Includes adding or replacing more than 40 CF -6R forms: MECH-04, MECH-2I-HERS linear feet of duct in unconditioned space. CF -4R forms: MECH-21 For split system or packaged units: Duct leakage < 15 percent ❑ EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos. Contractor (Documentation Author's /Responsible Designer's Declaration Statement) • I certify that this Certificate of Compliance documentation is accurate and complete. • I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of Compliance. • I certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24, Parts 1 and 6 of the California Code of Regulations. • The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with the permit application. Name: Kevin Robinson Signature: Kevin Robinson Company: I ANTHONY PLUMBING HEATING & AIR CONDITIONING Date: Nov 17, 2011 Address: 72216 NORTH SHORE ST #101 License: 777794 City/State/Zip: THOUSAND PALMS / CA / 92276 Phone: (760) 328-8096 Reg: 211-A0059944A-00000000-0000 2008 Residential Compliance Forms Registration Date/Time: 2011/11/17 12:58:44 HERS Provider: CalCERTS, Inc. July 2010 Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -IR -ALT -HVAC Climate Zones 10 - 15 Site Address: Enforcement Agency: Date: Permit #: 50115 ELDORADO DR La Quinta, CA 92253 City of La Quinta Nov 17, 2011 Duct insulation Conditioned Floor Equipment Typel List Minimum Efficiency2 requirement Area Thermostat ❑ Package Unit © Furnace 0 Indoor Coil © AFUE 78% p SEER 14.0 ❑ COP ❑ HSPF ❑ R 6 (CZ 10-13) Served by system R Setback If not already present, must be p Condensing Unit El EER E] Resistance ❑ R g CZ 14-15) 1800 sf installed) ❑ Other 1. Equipment Type: Choose the equipment being installed, if more than one system, use another CF -IR -ALT -HVAC for each system. 2. Minimum Equipment Efficiencies: 13 SEER, 78% AFUE, 7.7HSPF for typical residential systems. HERS VERIFICATION SUMMARY Listed below are FOUR HVAC alteration Options. The installer decides what work is being done and picks one of the appropriate Options. Each Option lists the HERS measures that must be conducted. A copy of the forms shall be left on site for final inspection and a copy given to the homeowner. At final, the inspector verifies that the work listed on this form was in fact the work completed by the installer. The inspector also verifies that each appropriate CF -6R and registered CF -4R forms (no hand filled CF-4Rs allowed) are filled out and Sig ned.Beginning October 1, 2010, a registered copy of the CF -1R and CF -6R shall also be on site for final inspection. © 1. HVAC Changeout Required Forms: . All HVAC Equipment CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS replaced CF -4R forms: MECH-21 and (for split systems) MECH-25 . Condenser Coil and /or • Indoor Coil and /or CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS . Furnace CF -4R forms: MECH-21 and (for split systems) MECH-25 I / s For Split Systems: Duct leakage < 15 percent; RC, CCA <_ 300 CFM/ton (Minimum Air Flow Requirement), TMAH Exempted from duct leakage testing if: ❑ 1.- Duct system 'was documented to have been previously sealed and confirmed through HERS verification, or ❑ 2. Duct systems with less than 40 linear feet in unconditioned space, or ❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos ❑,4. The,system•will not be Ducted (ie. Ductless Mini -Split System),(Also-Exempt from. Refrigerant Charge) ❑ 2. Nem HVAC System Required Forms: .Cut inlor Changeout with' new ducts: (all new CF -6R forms: MECH-04 MECH-20-HERS land (for split systems) MECH-22-HERS, and ducting and all new-- �, MECH=25sHER5 r CF -4R forms: MECH 20, and (for split systems) MECH-22, and MECH-25 equipment) � V/ :- / e- I,- For Split Systems: Duct leakage < 6 percent; RC, CCA >_ 350 CFM/ton, FWD; TMAH, STMS, and either HSPP or PSPP. For Packaged Units: Duct leakage < 6 percent ❑ 3. New Ducts with/or without Required Forms: Replacement . Includes replacing or installing all new ducting and/or outdoor condensing unit CF -6R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS and/or indoor coil and/or furnace. No or some CF -4R forms: MECH-20 and (for split systems) MECH-25 equipment changed. For Split Systems: Duct leakage < 6 percent; RC, CCA >_ 300 CFM/ton, TMAH For Packaged Units: Duct leakage < 6 percent ❑ 4. New Ducting over 40 feet Required Forms: . Includes adding or replacing more than 40 CF -6R forms: MECH-04, MECH-2I-HERS linear feet of duct in unconditioned space. CF -4R forms: MECH-21 For split system or packaged units: Duct leakage < 15 percent ❑ EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos. Contractor (Documentation Author's /Responsible Designer's Declaration Statement) • I certify that this Certificate of Compliance documentation is accurate and complete. • I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of Compliance. • I certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24, Parts 1 and 6 of the California Code of Regulations. • The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with the permit application. Name: Kevin Robinson Signature: Kevin Robinson Company: I ANTHONY PLUMBING HEATING & AIR CONDITIONING Date: Nov 17, 2011 Address: 72216 NORTH SHORE ST #101 License: 777794 City/State/Zip: THOUSAND PALMS / CA / 92276 Phone: (760) 328-8096 Reg: 211-A0059941A-00000000-0000 2008 Residential Compliance Forms Registration Date/Time: 2011/11/17 12:57:33 HERS Provider: CalCERTS, Inc. July 2010 Bin # City of La Quinta BuMing.BT Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # 1J�� 11' Project Address: SD�� Q �� Owner's Name: A. P. Number: Address:j Legal Description: City, ST, Zip: Contractor: Telephone: � � ;-��;:%�;.'•::y>o• :^•{.�:?• .. 'iY'.,. Y.,.?? Address: ANTHONY SSRVIGES Project Description: -1 City, ST, Zip: 72216 NORTH SHORE ST. STE 101TH9616AN9 PALMS, wn `h w.,• ;• ilJL::: i!:%i.:F+Gi:q: y'>'" X:i: Telephone: ..:�:;::.• ,:.-.•::.:{:: i' � State Lie. #:77 7 �'j City Lie. 11:10,5205V Arch., Engr., Designer: Address: City, ST, Zip: Telephone: • �.t � Utz..:>..>x�;;srw>?k�<:.;:�:m; Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo State Lie. #:w`�*~fs'? Name of Contact Person: CJ N tom! //I Sq. Ft.: # Sto'es: # Units: Telephone # of Contact Person: —�� i Estimated Value of Project � /4 �' APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cities. Reviewed, ready for corrections Plan Check Deposit Truss Cales. Called Contact Person Plan Check Balance Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2. Review, ready for corrections issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- '^' Review, ready for correctionsPissne Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees CERTIFICATE OF FIELD VERIFICATION SL DIAGNOSTIC TESTING CF-411-MECH-21 Duct Leakage Test - Existing Duct System (Page 1 of 2) Site Address: 50115 ELDORADO DR MASTER BED, La Quinta CA 92253 Enforcement Agency: Permit Number: (System 1) City of La Quinta 11-1243 Enter the Duct System Name or Identification/Tag: System 1 Enter the Duct System Location or Area Served: MASTER BED 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 Dlaanostic 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 outside less than 10% of Fan Flow ❑ 3. Reduce leakage by 60% and conduct smoke and fix all leaks O 4. Fix all accessible leaks using smoke and HERS rater verify Note: (One of Options:l, 2, or 3 must be attempted,before,uti.lizing Optlon,4.) , Determine, nominal Fan Flow using one of the following three calculation methods. 0' iJ s ✓ B Cooling rsystem method: Size of condenser in Tons 1,5" x 400 = t 2000 J CFM ✓ O Heating system method: 21.7x Output Capacity in Thousands of Btu/hr = _CFM ✓ 13 Measured,system,airflow, RA3.3'airflow using test procedures: CFM,,, Option 1 used then: 1 Allowed leakage = Fan Flow 2000 x 0.15 = 300 CFM Actual Leakage = 148 CFM Pass if Leakage Actual is less than Allowed Pass Fall Option 2 used then: 2 Allowed leakage = Fan Flow _ x 0.10 = _ CFM Actual Leakage to outside = _ CFM Pass if Leakage Actual is less than Allowed Pass Fail Option 3 used then: Initial leakage prior to start of work = _ CFM Final leakage after sealing all accessible leaks using smoke test = _ CFM 3 Initial leakage _ - Final leakage „_ = Leakage reduction _ CFM ((Leakage reduction _ / Initial leakage x 100% _ % Reduction Pass if % Reduction > 600i6 Ij Pass 0 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 0 Pass 0 Fail CERTIFICATE OF FIELD VERIFICATION A DIAGNOSTIC TESTING CF-4R-MECH-21 Duct Leakage Test — Existing Duct System (Page -2 -of 2) Site Address: 50115 EL DORADO DR MASTER BED, La Quinta CA 92253 Enforcement Agency: Permit Number: (System 1) City of La Quinta 11-1243 M Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off during duct leakage testing. CFI OA ducts that utilize controlled motorized dampers, that open only when OA ventilation is required to meet ASHRAE Standard 62.2, and close when OA ventilation is not required, may be configured to the closed position during duct leakage testing. ® All supply and return register boots'must be)sealedyto the drywall if,smoke test is utilized forIcompliance — applies'to duct leakage.c_omplianceaoption 3 (leakage reduction"by 60%) and option 44.(fix all accessible leaks) described above. f 7}Jr i (5sor-,,platfoirm rZ ® New duct installations cannot utilize buildiing cavities aasfplenu�rkurn/s�inIiL of d(6cjts/. F� ® Mastic and draw bands must be used in combination with cloth backed rubber adhesive duct tape to seal leaks at all new duct connections DECLARATION STATEMENT . I certify under penalty of perjury, under the laws of the State of California, the Information provided on this form Is true and correct. . I am the certified HERS rater who performed the verification services identified and reported on this certificate (responsible rater). • The installed feature, material, component, or manufactured device requiring HERS verification that is identified on this certificate (the installation) complies with the applicable requirements In Reference Residential Appendices RA2 and RA3 and the requirements specified on the Certificate(s) of Compliance (CF -111) approved by the local enforcement agency. • The Information reported on applicable sections of the Installation Certificate(s) (CF -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) ANTHONY PLUMBING HEATING A AIR CONDITIONING Responsible Person's Name: CSLB License: Kevin Robinson 1777794 HERS Provider Data Registry Information Sample Group # (if applicable): 286198 ® tested/verified dwelling ❑ not-tested/verified dwelling in la HERS sample group HERS Rater Information CaICERTS Certificate # CC1-1798608510 HERS Rater Company Name: All About Air Responsible Rater's Name: Responsible Rater's Signature: Roman Diaz Roman Diaz Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 2/2/2012 CC2004535 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-2S Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of S) Site Address: 50115 EL DORADO DR MASTER BED, La Quinta CA Enforcement Agency: Permit Number: 92253 City of La Quinta 11-1243 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 Handier System Name or Identification/Tag System i System Location or Area Served MASTER BED 1 ® Yes ❑ No 5/16 inch (8 mm) access hole upstream of evaporative coil in the return plenum and labeled according to Figure In Section RA3.2.2.2.2. 2 ® Yes ❑ No 5/16 inch (8 mm) access hole downstream of evaporative coil in the supply plenum and labeled according to Figure in Section RA3.2.2.2.2. Yes to 1 and 2 is a pass. Enter Pass or Faill ✓ ® Pass I ✓ ❑ Fail STMS - Sensoro on the Evaporator;Coil p� System Name or Identification/,Tag/./ f / System;i ;•` fi' l -/, 3 IThe s 13Yes N0 sensor is factory, installed, o, field installed according to manufacturer's specifications, or is installed by methods/specification's approved'by the,Executive 6 ❑ Yes f Director. + A t t i ! n r jf % i _. A / t - . The'sensor wire`is termi hated-, with a standard °mini,plug suitable -for connection to az�l 4 ❑ 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 5 ❑ Yes ❑ No When attached to a digital thermometer, the sensor provides an indication of the saturation temperature of the coil. Yes to 3, 4, and 5 is a pass. Enter N/A if STMS are not ✓ ®N/A ✓ E3 Pass ✓ 13 Fail applicable. Otherwise enter Pass or Fail STMS - Sensor on the Condenser Coil System Name or Identification/Tag I System i 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. -7 Yes to 6, 7, and 8 is a pass. Enter N/A if STMS are not ✓ ®N/A ✓ [3 Pass ✓ ❑ Fall applicable. Otherwise enter Pass or Fail Lei 'Vti CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5) Site Address: 50115 ELDORADO DR MASTER BED, La Quinta CA Enforcement Agency: Permit Number: 92253 City of La Quinta 11-1243 Standard Charge Measurement Procedure (for use if outdoor air dry-bulb is above 55°F) Procedures for determining Refrigerant Charge using the Standard Charge Measurement Procedure are available in Reference Residential Appendix RA3.2. As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional form(s) for any additional systems in the dwelling as applicable. • The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure. • The system must meet minimum airflow requirements as prerequisite for a valid refrigerant charge test. • If outdoor air dry-bulb is 55°F or below, the installer must use the Alternate Charge Measurement Procedure. Space Conditioning Systems System Name or Identification/Tag System 1 re -calibrated monthly) 1t 7 s y �f , v � k System Location or Area Served MASTER BED • 11/15/2012 /` (must be re -calibrated monthly) Outdoor Unit Serial # 1110546891 Outdoor Unit Make AMANA Outdoor Unit Model ASX1406016B Nominal Cooling Capacity Btu/hr 60000 Date of Verification 2/2/2012 Calibration of D(agnostic Instruments Date of Refrigerant Gauge Calibration r! -i i/-15/2012 1(must;be f re -calibrated monthly) 1t 7 s y �f , v � k t- !� r Ni Date of Thermocouple Calibration , *f • 11/15/2012 /` (must be re -calibrated monthly) Supply (evaporator leaving) air dry-bulb 56 Measured Temperatures (,F) it I 1 1. I• i k i w, ` N 1, - ).0.A'. .r i 0 0i f _rr System Name. orldentification/Tag , Systein,i Supply (evaporator leaving) air dry-bulb 56 temperature (Tsupply, db) Return (evaporator entering) air dry-bulb 78 temperature (Treturn, db) Return (evaporator entering) air wet -bulb 57 temperature (Treturn, wb) Evaporator saturation temperature 31 (Tevaporator, sat) Condensor saturation temperature 91 (Tcondensor, sat) Suction line temperature (Tsuction) 50 Liquid Line Temperature (Tliquid) 80 Condenser (entering) air dry-bulb 75 temperature (Tcondenser, db) :i INSTALLATION CERTIFICATE CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5) Site Address: 50115 ELDORADO DR MASTER BED, La Quinta CA Enforcement Agency: Permit Number: 92253 City of La Quinta 11-1243 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, 22.00 db - Tsupply, db Target Temperature Split from Table RA3.2-3 23.5 using Treturn, wb and Treturn, db Calculate difference: Actual Temperature Split - -1.5 Target Temperature Split = Passes if difference is between -4°F and +4°F or, upon remeasurement, if between -4°F and PASS -100°F Enter Pass or Faill Note: Temperature Split Method Calculation is not necessary if actual Cooling Coll Airflow is verified using one of the airflow measurement procedures specified in Reference Residential Appendix RA3.3. If actual cooling coil airflow is measured, the value must be equal to or greater than the Calculated Minimum Airflow Requirement in the table below. Calculated Minimum Airflow Requirement (_CFM) = Nominal Cooling Capacity (ton) X 300 (cfm/ton) System Name or Identification/Tag Calculated Minimum, Airflow'Requirement"(CFM) pt y k "'tiq.. T�""^.' +:.-r �..�-:- 1+.%-" . --• `7�'^ar. Measured Airflow using RA3.3 procedures (CFM) �.,a,.-.a _.�.aarhr:,.� ++.^...-„ . -�....,.vr+�fi�--ti«,,�.^ k. N "'i"JsrK'" �j 4..-r- �!' °tet" � Passes if measured airflow is greater than or equal to the calculated minimum airflow requirement. Enter Pass or Fail. Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for fixed orifice metering device systems System Name or Identification/Tag Calculate: Actual Superheat = Tsuction - Tevaporator, sat Target Superheat from Table RA3.2-2 using Treturn, wb and Tcondenser, db Calculate difference: Actual Superheat - Target Superheat = System passes if difference is between -6°F and +6°F Enter Pass or Fail, INSTALLATION CERTIFICATE CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5) Site Address: 50115 EL DORADO DR MASTER BED, La Quinta CA Enforcement Agency: Permit Number: 92253 City of La Quinta 11-1243 Subcooling Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag System 1 Calculate: Actual Subcooling = 11.0 Tcondenser, sat - Tliquid Target Subcooling specified by manufacturer 10 Calculate difference: 1 Actual Subcooling - Target Subcooling = ?"T\ System passes if difference is between h — PASS 1. I -4°F and +4°F PASS Enter Pass or Fail Metering Device Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag System 1 Calculate: Actual Superheat = 19.0 Tsuction - Tevaporator, sat Enter allowable superheat range from manufacturer's specifications (or use range 4-25 between 3°F and 260F if manufacturer's specification,is'not available) ?"T\ System passes if actual superheat is within the allowable superheat range._ /, J I ( h — PASS 1. I f ]Enter, Pass or Fail }`"' INSTALLATION CERTIFICATE CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5) Site Address: 50115 ELDORADO DR MASTER BED, La Quinta CA Enforcement Agency: Permit Number: 92253 City of La Quinta 11-1243 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 777794 HERS Provider Data Registry Information Sample Group # (if applicable): 286198 System meets all refrigerant charge and airflow ❑ not-tested/verifled dwelling in la HERS sample group requirements. PASS All About Air Responsible Rater's Name: Responsible Rater's Signature: Enter Pass or Fal Roinan Diaz Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 2/2/2012 CC2004535 i DECLARATION STATEMENT • I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. . I am the certified HERS rater who performed the verification services Identified and reported on this certificate (responsible rater). • The Installed feature, material, component, or manufactured device requiring HERS verification that is Identified on this certificate (the Installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified on the Certlflcate(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 Certlflcate(s) of Compliance (CF -1R) approved by the enforcement agency. Builder or Installer information as shown on the Installation Certificate (CF -61111) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) 3 ANTHONY PLUMBING HEATING A AIR CONDITIONING Responsible Person's Name: CSLB License: Kevin Robinson 777794 HERS Provider Data Registry Information Sample Group # (if applicable): 286198 ® tested/verified dwelling ❑ not-tested/verifled dwelling in la HERS sample group HERS Rater Information CaICERTS Certificate # CCl-1798608510 HERS Rater Company Name: All About Air Responsible Rater's Name: Responsible Rater's Signature: Roman Diaz Roinan Diaz Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 2/2/2012 CC2004535 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-21 Duct Leakage Test - Existing Duct System (Page 1 of 2) Site Address: 50115 ELDORADO DR. LIVING ROOM, La Quinta CA 92253 Enforcement Agency; Permit Number: (System 1) City of La Quinta 11-1243 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. O 1. Measured leakage less than 15% of fan flow 2. Measured leakage to outside less than 10% of Fan Flow 0 3. Reduce leakage by 60% and conduct smoke and fix all leaks r3 4. 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 nominal Fan Flow using one ofthe following three calculation methods.` I ✓ 13 Cooling system method: Size of 'condenser in Tons ` x 400 = `CFM ✓ 0 Heating system mfe{{thod: 21..7 x _ Output Capacity.in Thousands of Btu/hr = _ CFM ✓ 13 Measured. system .airflow;Using, RA3:3'airElow test, procedures:_,CFM,_ Option 1 used then: 1 Allowed leakage = Fan Flow_ x 0.15 = _ CFM Actual Leakage = _ CFM Pass if Leakage Actual is less than Allowed Pass Fail Option 2 used then: 2 Allowed leakage = Fan Flow_ x 0.10 = _ CFM Actual Leakage to outside = _ CFM Pass if Leakage Actual is less than Allowed 0 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% E3 Pass p Fail Option 4 used then: 4 All accessible leaks repaired using smoke. HERS rater must verify (No sampling). No smoke allowed to leak from system. Including ducts, plenums, air handler and door panel. Pass if all accessible leaks have been repaired using smoke Pass M Fall CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-21 Duct Leakage Test - Existing Duct System (Page 2 of 2) Site Address: 50115 EL DORADO DR. LIVING ROOM, La Quinta CA 92253 Enforcement Agency: Permit Number: (System 1) City of La Quinta 11-1243 ❑ 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 d return register b ots'mus' st be5sealed he drywall �if s oke to utilized d fro compliance - applies'to duct leakage,compliance` option 3 (leakage reductionrby 60%) and option 4k(fix all accessible leaks) described above" - 4 r r � 4. � � 1 ❑ New duct instyalla£tions canno+�t�rutilize. building cavities aslplenums or:platform returns in lieu ofd ts. Ic C) Mastic and draw bands must be used in combination with cloth backed rubber adhesive duct tape to seal leaks at all new duct connections DECLARATION STATEMENT • I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. • I am the certified HERS rater who performed the verification services Identified and reported on this certificate (responsible rater). • The Installed feature, material, component, or manufactured device requiring HERS verification that Is Identified on this certificate (the Installation) complies with the applicable requirements In Reference Residential Appendices RA2 and RA3 and the requirements specified on the Certificate(s) of Compliance (CF -IR) 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 Certificates) of Compliance (CF -111) approved by the enforcement agency. Builder or Installer information as shown on the Installation Certificate (CF -6R) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) 3 ANTHONY PLUMBING HEATING & AIR CONDITIONING Responsible Person's Name: CSLB License: Kevin Robinson 1777794 HERS Provider Data Registry Information Sample Group # (if applicable): 286198 ❑ tested/verified dwelling®ERS not-tested/verified dwelling in a H sample group HERS Rater Information Ca10ERTS Certificate # CC1-1798626780 HERS Rater Company Name: All About Air Responsible Rater's Name: Responsible Rater's Signature: Roman Diaz Roman Diaz Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 2/2/2012 CC2004535 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 5) Site Address: 50115 ELDORADO DR. LIVING ROOM, La Quinta CA Enforcement Agency: Permit Number: 92253 City of La Quinta 11-1243 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 Supply and Return Plenums of Air Handier System Name or Identificatlon/Tag 3 System Location or Area Served I r ❑ No 1 ❑ Yes ❑ No 5/16 inch (8 mm) access hole upstream of evaporative coil in the return plenum and labeled according to Figure in Section RA3.2.2.2.2. 2 ❑ Yes ❑ No 5/16 inch (8 mm) access hole downstream of evaporative coil in the supply plenum and labeled according to Figure in Section RA3.2.2.2.2. Yes to 1 and 2 is a pass. Enter Pass or Faill ✓ ❑ Pass ✓ ❑ Fail STMS - Sensor on the Evaporator,Coil,,� t,r' i Iry System Name or Identification/Tagf i / i 3 p Yes I r ❑ No The sensor is factory installed, or field installed according to manufacturer's specifications, or is installed by meth6ds/specificati6ns approved'by'the,Executive 6 ❑ Yes ❑ No Director. ks A I �i` ii ,l _ The sensor wire1s terminated with a standardmini! plug suitable for connection•to a- 4 ❑ 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 5 ❑ Yes ❑ No When attached to a digital thermometer, the sensor provides an indication of the saturation temperature of the coil. Yes to 3, 4, and 5 is a pass. Enter N/A if STMS are not ✓ ❑ N/A ✓ ❑Pass ✓ [3 Fail applicable. Otherwise enter Pass or 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 ✓ 10 N/A✓ Pass OP ✓ ❑Fail applicable. Otherwise enter Pass or Fail CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5) Site Address: 50115 ELDORADO DR. LIVING ROOM, La Quinta CA Enforcement Agency: Permit Number: 92253 City of La Quinta 11-1243 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 /n 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 -rte � �{must,be-re-calibrated monthly) ./ V S i ✓r 1� System Location or Area Served Date of Thermocouple Calibration J�f f (must be re -calibrated monthly) I k f 9 i t 4' Outdoor Unit Serial # Outdoor Unit Make Outdoor Unit Model Nominal Cooling Capacity Btu/hr Date of Verification Calibration of Diagnostic Instruments Date of Refrigerant Gauge Calibration �.; -rte � �{must,be-re-calibrated monthly) ./ V S i ✓r 1� a ;1 W, f V Date of Thermocouple Calibration J�f f (must be re -calibrated monthly) I k f 9 i t 4' temperature (Tsupply, db) Measured Temperatures,(°F) If, I f- f g a I / System Name or, Identification/Tag` ��. s,. + Supply (evaporator leaving) air.dry-bulb temperature (Tsupply, db) Return (evaporator entering) air dry-bulb temperature (Treturn, db) Return (evaporator entering) air wet-bufb temperature (Treturn, wb) Evaporator saturation temperature (Tevaporator, sat) Condensor saturation temperature (Tcondensor, sat) Suction fine temperature (Tsuction) Liquid Line Temperature (Tliquid) Condenser (entering) air dry-bulb temperature (Tcondenser, db) M INSTALLATION CERTIFICATE CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5) Site Address: 50115 ELDORADO DR. LIVING ROOM, La Quinta CA Enforcement Agency: Permit Number: 92253 City of La Quinta 11-1243 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 Tretum, 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 Fall] Note: Temperature Split Method Calculation is not necessary if actual Cooling Coil Airflow is verified using one of the airflow measurement procedures specified in Reference Residential Appendix RA3.3. If actual cooling coil airflow is measured, the value must be equal to or greater than the Calculated Minimum Airflow Requirement in the table below. Calculated Minimum Airflow Requirement (CFM) = Nominal Cooling Capacity (ton) X 300 (cfm/ton) System Name or Identification/Tag Calculated Minimum Airfl w,Requireinent (CFM) .!71 ra^ A 1J Measured'Airflow using,RA3.3''procedures.(CFM);� . Passes if measured airflow is greater than or equal to the calculated minimum airflow requirement. Enter Pass or Fail Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for fixed orifice metering device systems System Name or Identification/Tag Calculate: Actual Superheat = Tsuction - Tevaporator, sat Target Superheat from Table RA3.2-2 using Treturn, wb and Tcondenser, db Calculate difference: Actual Superheat - Target Superheat = System passes if difference is between -6°F and +6°F Enter Pass or Fai S INSTALLATION CERTIFICATECF-4R-MECH-25 Refrigerant Charge Verification --standard Measurement Procedure (Page 4 of 5) Site Address: 50115 ELDORADO DR. LIVING ROOM, La Quinta CA Enforcement Agency: Permit Number: 92253 City of La Quinta 11-1243 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 - Tllquid Target Subcooling specified by manufacturer Calculate difference: Actual Subcooling - Target Subcooling = j�,? 1' 1-7"V System passes if difference is between -4°F and +4°F Enter Pass or Fail Metering Device Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag Calculate: Actual Superheat = Tsuction - Tevaporator, sat Enter allowable superheat range from manufacturer's specifications (or use range between 3°F and 260F if manufacturer's speclfication,is:not available) .sp j�,? 1' 1-7"V System passes if actual superheat is within the allowable'su erheat range ► P 9 Pass �{ > ,Entr or Fail INSTALLATION CERTIFICATE CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5) Site Address: 50115 EL DORADO DR. LIVING ROOM, La Quinta CA Enforcement Agency: Permit Number: 92253 City of La Quinta 11-1243 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 Kevin Robinson 1777794 HERS Provider Data Registry Information Sample Group # (if applicable): 286198 System meets all refrigerant charge and airflow a not-tested/verified dwelling in a HERS sample group requirements. HERS Rater Company Name: All About Air Responsible Rater's Name: Responsible Rater's Signature: Enter Pass or Fail Roman Diaz Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 2/2/2012 CC200453S 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 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 -611), signed and submitted by the person(s) responsible for the Installation conforms to the requirements specified on the Certlficate(s) of Compliance (CF -111) approved by the enforcement agency. Builder or Installer information as shown on the Installation Certificate (CF -6R) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) I ANTHONY PLUMBING HEATING R AIR CONDITIONING Responsible Person's Name: CSLB License: Kevin Robinson 1777794 HERS Provider Data Registry Information Sample Group # (if applicable): 286198 ❑ tested/verified dwelling a not-tested/verified dwelling in a HERS sample group HERS Rater Information Ca10ERTS Certificate # CCI -1798626780 HERS Rater Company Name: All About Air Responsible Rater's Name: Responsible Rater's Signature: Roman Dias Roman Diaz Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 2/2/2012 CC200453S CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-21 Duct Leakage Test - Existing Duct System (Page 1 of 2) Site Address: 50115 EL DORADO DR KITCHEN, La Quinta CA 92253 Enforcement Agency: Permit Number: (System 1) City of La Quinta 11-1243 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 4. Fix all accessible leaks using smoke and HERS rater verify Note: (One of Options 1, 2, or 3 must be attempted, before utilizing Option,4.), Determine, nominal Fan Flow using one of:the followlhg three calculation methods."" }' ✓ O Coolig system method Size of condenser in fons.Lj x�4y00= f' €CFM-. PFM 13 Heating systemicmethod: 21.7 x Output Capacity in Thousands ofBtu/hr = °sCFM' ✓ Measured,syse: eiff' w sing'RA3 3'airflow test procedures: Option 1 used then: 1 Allowed leakage = Fan Flow _ x 0.15 = _ CFM Actual Leakage = _ CFM Pass if Leakage Actual is less than Allowed Pass Fail Option 2 used then: 2 Allowed leakage = Fan Flow_ x 0.10 = _ CFM Actual Leakage to outside = _ CFM Pass if Leakage Actual is less than Allowed Pass Fail Option 3 used then: Initial leakage prior to start of work = _ CFM Final leakage after sealing all accessible leaks using smoke test = CFM 3 Initial leakage _ - Final leakage _ = Leakage reduction CFM ((Leakage reduction _ / Initial leakage _) x 100% _ % Reduction Pass if % Reduction > 60% 0 Pass 0 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 p Pass Q Fail CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-21 Duct Leakage Test - Existing Duct System (Page 2 of 2) Site Address: 50115 EL DORADO DR KITCHEN, La Quinta CA 92253 Enforcement Agency: Permit Number: (System 1) City of La Quinta 11-1243 ❑ 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. O All supply,�and return register boots'must be sealed'.to the drywall if,smoke test is utilized for compliance - applies'to duct leakage,,compliance option 3 (leakage reductioniby 60%) and option 4�(fix all accessible leaks) d''&scribed abov�Fe. ❑New duct installations`,cannot utilize buildingJcavit_iies a asfplenums.or:platform,returns" m lien of U7 s.....t� ✓ �-,� -W,"+ . _�.«. 4G,.✓ ,A ❑ Mastic and draw bands must be used in combination with cloth backed rubber adhesive duct tape to seal leaks at all new duct connections DECLARATION STATEMENT • I certify under penalty of perjury, under the laws of the State of California, the Information provided on this form Is true and correct. • I am the certified HERS rater who performed the verification services Identified and reported on this certificate (responsible rater). • The Installed feature, material, component, or manufactured device requiring HERS verification that is identified on this certificate (the Installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified on the Certificate(s) of Compliance (CF -111) approved by the local enforcement agency. • The information reported on applicable sections of the Installation Certificate(s) (CF -611), signed and submitted by the person(s) responsible for the Installation conforms to the requirements specified on the Certiflcate(s) of Compliance (CF -1R) 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) 3 ANTHONY PLUMBING HEATING & AIR CONDITIONING Responsible Person's Name: CSLB License: Kevin Robinson 1777794 HERS Provider Data Registry Information Sample Group # (if applicable): 286198 ❑ tested/verified dwelling ® not-tested/verified dwelling in a HERS sample group HERS Rater Information CalCERTS Certificate * CCi-1798608513 HERS Rater Company Name: All About Air Responsible Rater's Name: Responsible Rater's Signature: Roman Diaz Roman Diaz Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 2/2/2012 CC2004535 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: 50115 ELDORADO DR KITCHEN, La Quinta CA 92253 City of La Quinta 11-1243 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 3 System Location or Area Served p No 1 ❑ Yes ❑ No 5/16 inch (8 mm) access hole upstream of evaporative coil in the return plenum and labeled according to Figure in Section RA3.2.2.2.2. 2 ❑ Yes ❑ No 5/16 inch (8 mm) access hole downstream of evaporative coil in the supply plenum and labeled according to Figure in Section RA3.2.2.2.2. Yes to 1 and 2 is a pass. Enter Pass or Faill ✓ ❑ Pass ✓ ❑Fall STMS - Sensor on,the Evaporator Coil. System Name or Identification/Tag j �'•,f . r g ( ) j F f- 4 tj 3 i ❑Yes p No The sensor is factory.installed, orfield installed according to manufacturer's spedflcations, or islinstalled by methods/specifications approved by, the Executive 6 ❑ Yes ❑ No Director. ( r �) ` ' 4 r� ,c s ✓ 4 ❑,Yes ..- p No'`4 The sensor wire is terminated with a standard mini plug suitable for.connection,to a; digital:thermometer. The sensor mini plug"is accessible to the install ing:techniclan k5= 7 ❑ Yes ❑ No and the HERS rater without changing the airflow through,the condenser coil 5 ❑Yes ❑ No When attached to a digital thermometer, the sensor provides an indication of the 8 ❑ Yes ❑ No saturation temperature of the coil. Yes to 3, 4, and 5 is a pass. Enter N/A if STMS are not ✓ E; 7A ✓ ❑ Pass ✓ ❑ Fall applicable. Otherwise enter Pass or Fail ✓ ® N/A ✓ 0Pass ✓ [3 Fall 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 ✓ 0Pass ✓ [3 Fall applicable. Otherwise enter Pass or Fail 0 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: 50115 EL DORADO DR KITCHEN, La Quinta CA 92253 City of La Quinta 11-1243 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 Svstems System Name or Identification/Tag (must be re -calibrated monthly) Date of Thermocouple Calibration/,ff r } System Location or Area Served Outdoor Unit Serial # Outdoor Unit Make Outdoor Unit Model Nominal Cooling Capacity Btu/hr Date of Verification calibration of Diagnostic instruments Date of Refrigerant Gauge Calibration (must be re -calibrated monthly) Date of Thermocouple Calibration/,ff r } (must be re -calibrated monthly) measurea,lemperatures t,r-1 it i! I i f. g. \. o System Name or Identification/Tag Supply (evaporator leaving)'air dry-bulb temperature (Tsupply, db) Return (evaporator entering) air dry-bulb temperature (Tretum, db) 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 (Thquid) Condenser (entering) air dry-bulb temperature (Tcondenser, db) A INSTALLATION CERTIFICATE CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5) Site Address: Enforcement Agency:711-1243 rmit Number: 50115 EL DORADO DR KITCHEN, 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 Calculate: Actual Temperature Split = Treturn, db " Tsupply, db Target Temperature Split from Table RA3.2-3 using Treturn, wb and Treturn, db Calculate difference: Actual Temperature Split - Target Temperature Split = Passes if difference is between -4°F and +4°F or, upon remeasurement, if between -4°F and -100°F Enter Pass or Fail Note: Temperature Split Method Calculation is not necessary if actual Cooling Coil Airflow is verified using one of the airflow measurement procedures specified in Reference Residential Appendix RA3.3. If actual cooling coil airflow is measured, the value must be equal to or greater than the Calculated Minimum Airflow Requirement in the table below. Calculated Minimum Airflow Requirement (CFM) = Nominal Cooling Capacity (ton) X 300 (cfm/ton) System Name Ide �fication/Tag�.�r �or Calculated,Minimum Airflow.,Requirement (CFM) Measured Airflow using RA3.3 procedures (CFM) ;; N, Passes if measured airflow is greater than or equal to the calculated minimum airflow requirement. Enter Pass or Faill 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 Fai INSTALLATION CERTIFICATE CF-411-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5) Site Address: Enforcement Agency: 71111243 mit Plumber: 50115 EL DORADO DR KITCHEN, La Quinta CA 92253 City of La Quinta Subcooling Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification%Tag Calculate: Actual Subcooling = Tcondenser, sat - Tliquid Target Subcooling specified by manufacturer Calculate difference: Actual Subcooling - Target Subcooling = System passes if difference is between -4°F and +4°F IF� Enter Pass or Faill '� Metering Device Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag Calculate: Actual Superheat = 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 passes'if actual superheat is'within,the allowable superheat r5nge IF� Enter' Pass or Fai, '� {'• ,,, ,� INSTALLATION CERTIFICATE CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5) Site Address: Enforcement Agency: Permit Number: 50115 EL DORADO DR KITCHEN, La Quinta CA 92253 City of La Quinta 11-1243 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 Kevin Robinson 1777794 HERS Provider Data Registry Information Sample Group # (if applicable): 286198 System meets all refrigerant charge and airflow not-tested/verified dwelling in la HERS sample group requirements. HERS Rater Company Name: All About Air Responsible Rater's Name: Responsible Rater's Signature: Enter Pass or Fail Roman Diaz Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 2/2/2012 CC2004535 DECLARATION STATEMENT . I certify under penalty of perjury, under the laws of the State of California, the information provided on this form Is true and correct. • I am the certified HERS rater who performed the verification services Identified and reported on this certificate (responsible rater). • The Installed feature, material, component, or manufactured device requiring HERS verification that is Identified on this certificate (the Installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified on the Certificate(s) of Compliance (CF -111) approved by the local enforcement agency. • The Information reported on applicable sections of the Installation Certificate(s) (CF -6R), signed and submitted by the person(s) responsible for the Installation conforms to the requirements specified on the Certlficate(s) of Compliance (CF -111) approved by the enforcement agency. Builder or Installer information as shown on the Installation Certificate (CF -6R) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) 3 ANTHONY PLUMBING HEATING A AIR CONDITIONING Responsible Person's Name: CSLB License: Kevin Robinson 1777794 HERS Provider Data Registry Information Sample Group # (if applicable): 286198 ❑ tested/verified dwelling not-tested/verified dwelling in la HERS sample group HERS Rater Information CaICERTS Certificate # CCI -1798608513 HERS Rater Company Name: All About Air Responsible Rater's Name: Responsible Rater's Signature: Roman Diaz Roman Diaz Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 2/2/2012 CC2004535 Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-lR-ALT-HVAC Climate Zones 10 - 15 Site Address: Enforcement Agency: Date: Permit #: 50115 EL DORADO DR MASTER BED La Quinta, CA 92253 City of La Qui nta Feb 2, 2012 Duct insulation Conditioned Floor Equipment Typel List Minimum Efficiency2 requirement Area Thermostat ❑ Package Unit ® Furnace 0 AFUE % []COP_ ❑ R 6 (CZ 10-13) Served by system Setback m Indoor Coil m SEER 14,0 ❑ HSPF ❑ R 8 (CZ 14-I5) 1800 sf If not already present, must be ® Condensing Unit ❑ EER ❑ Resistance installed) ❑ Other 1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF-IR-ALT-HVAC for each system. 2. Minimum Equipment Efficiencies: 13 SEER, 78% AFUE, 7.7HSPF for typical residential systems. HERS VERIFICATION SUMMARY Listed below are FOUR HVAC alteration Options. The installer decides what work is being done and picks one of the appropriate Options. Each Option lists the HERS measures that must be conducted. A copy of the forms shall be left on site for final inspection and a copy given to the homeowner. At final, the inspector verifies that the work listed on this form was in fad the work completed by the Installer. The inspector also verifies that each appropriate CF-6R and registered CF-4R forms (no hand filled CF-411s allowed) are filled out and signed.Beginning October 1, 2010, a registered copy of the CF-111 and CF-611 shall also be on site for final inspection. ® 1. HVAC Changeout Required Forms: • All HVAC Equipment CF-6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS replaced CF-4R forms: MECH-21 1 1 1NOand (for split systems) MECH-25 • Condenser Coil and /or • Indoor Coil and /or CF-6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS • Furnace CF-4R forms: MECH-21 and (for split systems) MECH-25 For Split Systems, Duct leakage < 15 percent; RC, CCA _< 300 CFM/ton (Minimum Air Flow Requirement), TMAH Exempted from duct leakage testing if: ❑ 1. Duct system was documented to have been previously sealed and confirmed through HERS verification, or ❑ 2. Duct systems with less than 40 linear feet in unconditioned space, or ❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos ❑ 4. The system will not be Ducted (ie. Ductless Mini-Split System) (Also Exempt from Refrigerant Charge) ❑ 2. New HVAC System Required Forms: . Cut in or Changeout with new duds: (all new CF-6R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-22-HERS, and ducting and all new MECH-25-HERS CF-4R forms: MECH 20, and (for split systems) MECH-22, and MECH-25 equipment) For Split Systems: Duct leakage < 6 percent; RC, CCR >_ 350 CFM/ton, FWD, TMAH, STMS, and either HSPP or PSPP. For Packaged Units: Duct leakage < 6 percent ❑ 3. New Ducts with/or without Required Forms: Replacement . Includes replacing or installing all new ducting and/or outdoor condensing unit CF-6R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS and/or indoor coil and/or furnace. No or some CF-4R forms: MECH-20 and (for split systems) MECH-25 equipment changed. For Split Systems: Duct leakage < 6 percent; RC, CCA >_ 300 CFM/ton, TMAH For Packaged Units: Duct leakage < 6 percent 114. New Ducting over 40 feet Required Forms: . Includes adding or replacing more than 40 CF-6R forms: MECH-04, MECH-2I-HERS linear feet of dud in unconditioned space. CF-411 forms: MECH-21 For split system or packaged units: Duct leakage < 15 percent ❑ EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos. Contractor (Documentation Author's /Responsible Designer's Declaration Statement) • I certify that this Certificate of Compliance documentation is accurate and complete. • I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design Identified on this Certificate of Compliance. • I certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24, Parts 1 and 6 of the California Code of Regulations. • The design features identified on this Certificate of Compliance are consistent with the Information documented on other applicable compliance forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with the permit application. Name: Signature: Company: J ANTHONY PLUMBING HEATING & AIR CONDITIONING Date: Nov 17, 2011 Address: 72216 NORTH SHORE ST #101 License: 777794 City/State/Zip: THOUSAND PALMS / CA / 92276 Phone: (760) 328-8096 Reg: 211-AO0599418-00000000-0000 Registration Date/Time: 2011/11/17 12:57:33 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms July 2010 INSTALLATION CERTIFICATE CF-6111-MECH-2I-09 Duct Leakage Test — Existing Duct System (Page 1 of 2) Site Address: 50115 EL DORADO DR MASTER BED, La Quinta CA 92253 Enforcement Agency: City of La Quinta Permit Number: 11-1243 (System 1) 4. Fix all accessible leaks using smoke and HERS rater verify Enter the Duct System Name or Identification/Tag: System 1 Enter the Duct System Location or Area Served: MASTER BED Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the dwelling. This installation certificate is required for compliance for alterations and additions in existing dwellings to space conditioning systems and duct systems. Note: For existing dwellings, a completely new or replacement duct system can also include existing parts of the original duct system (e.g., register boots, air handler, coil, plenums, etc.) if those parts are accessible and they can be sealed. For a completely new or replacement duct system installed in an existing dwelling, use the Installation Certificate titled "Duct Leakage Test - Completely New or Replacement Duct System. " Duct Leakage Diagnostic Test - existing duct system Select one compliance method from the following four choices. 0 1. Measured leakage less than 15% of fan flow O 2. Measured leakage to outside less than 10% of Fan Flow 3. Reduce leakage by 60% and conduct smoke and fix all leaks 4. Fix all accessible leaks using smoke and HERS rater verify Note: (One of Options 1, 2 or 3 must be attempted before utilizing Option Determine nominal Fan Flow using one of,the following three calculation methods..r } r r ✓ I� y V 0 Cooling system method: Size of condenser in Tons 5 x 400 = 2000 -CFM V 11 Heating system meth od : 21.71x r Output Capacity, in Thousands of, Btu/hr = _� CFM V ❑ Measured_system airflow us1ng,-RA3.3'airflow; test.procedures:: - CFM,,. Option i used then: " 1 Allowed leakage = Fan Airflow 2000 x 0.15 = 300 CFM Actual Leakage = 148 CFM Pass if Actual Leakage is less than Allowed leakage Pass Fail Option 2 used then: 2 Allowed leakage = Fan Airflow _ x 0.10 = _ CFM Actual Leakage to outside =CFM Pass if Actual leakage to outside is less than Allowed leakage Pass afaiL 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 0 Pass Fail 0 INSTALLATION CERTIFICATE CF-6R-MECH-2I-HER9 Duct Leakage Test — Existing Duct System (Page 2 of 2) Site Address: 50115 ELDORADO DR MASTER BED, La Quinta CA 92253 Enforcement Agency: City of La Quinta Permit Number: 11-1243 (System 1) Position With Company (Title): 777794 G5 Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off during duct leakage testing. CFI OA ducts that utilize controlled motorized dampers, that open only when OA ventilation is required to meet ASHRAE Standard 62.2, and close when OA ventilation is not required, may be configured to the closed position during duct leakage testing. 0 All supply'iI id return register boots -must be,sealedito 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 duct installations cannot'utillze building cavities as-plenums'or platform ct returns in lieu of dus.; a ,� �,w ♦ ,,y7r � -.� �:' � :� l ti , •--w+' �3.. � r ® Mastic and draw bands must be used in combination with cloth backed rubber• adhesive duct tape to seal leaks at all new duct connections DECLARATION STATEMENT • I certify under penalty of perjury, under the laws of the State of California, the information provided on this form Is true and correct. • I am 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 tow -rise residential buildings. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) 3 ANTHONY PLUMBING HEATING & AIR CONDITIONING Responsible Person's Name: Responsible Person's Signature: Kevin Robinson Kevin Robinson CSLB License: Date Signed: Position With Company (Title): 777794 11/20/2011 Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? 0 Yes 0 No INSTALLATION CERTIFICATE* CF-611-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 5) Site Address: 50115 EL DORADO DR MASTER BED, La Quinta CA Enforcement Agency: Permit Number: 92253 City of La Quinta 11-1243 Note: If installation of a Charge Indicator Display (CID) is utilized as an alternative to refrigerant charge verification for compliance, a MECH-24 Certificate (instead of this MECH-25 Certificate) should be used to demonstrate compliance with the refrigerant charge verification requirement. TMAH and STMS are not required for compliance, when a CID is utilized for compliance. As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional form(s) for any additional systems in the dwelling as applicable. Temperature Measurement Access Holes (TMAH) and Saturation Temperature Measurement Sensors (STMS) Procedures for Installing TMAH are specified in Reference Residential Appendix RA3.2. If refrigerant charge verification is required for compliance, TMAH are also required for compliance. STMS are only required for completely new or replacement space -conditioning systems that utilize prescriptive compliance method. TMAH - Access Holes in Supply and Return Plenums of Air Handler System Name or Identification/Tag System 1 System Location or Area Served MASTER BED 1 Q Yes ❑ No 5/16 inch (8 mm) access hole upstream of evaporative coil in the return plenum and labeled according to Figure in Section RA3.2.2.2.2. 2 0 Yes ❑ No 5/16 inch (8 mm) access hole downstream of evaporative coil in the supply plenum and labeled according to Figure in Section RA3.2.2.2.2. Yes to 1 and 2 is a pass. Enter Pass or Faill ✓ m Pass ✓ ❑ Fail STMS - Sensor o Hie EvaporatoriCoil System Name or Identification/Tagpj.� / System'1 7.. w: i 1 3 ❑ Yes The sensor is factory installed, orrfield,installed according to manufacturer's specifications, or is installed by methods/specifications approved,tiy'the Executive 6 ❑ Yes f❑:No / Director. `" Itfr I,' `-.ria ;, •a'° S The sensor„wire is terminated iwith,a standard mini plug suitable for connection.to a�+ 4 ❑ Yes ❑ No digital thermometer.'The sensor mini plug is accessible to the installing technician 7 ❑ Yes ❑ No 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 3, 4, and 5 is a pass. Enter N/A if STMS are not ✓ p N/A ✓ ❑ Pass ✓ ❑ Fail applicable. Otherwise enter Pass or Fail p N/A ✓ ❑Pass ✓ ❑Fail STMS - Sensor on the Condenser Coil System Name or Identification/Tag I System i 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 ✓ ❑Pass ✓ ❑Fail applicable. Otherwise enter Pass or Fail ESI INSTALLATION CERTIFICATE CF-611-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5) Site Address: 50115 ELDORADO DR MASTER BED, La Quinta CA Enforcement Agency: Permit Number: 92253 City of La Quinta 11-1243 Standard Charge Measurement Procedure (for use if outdoor air dry-bulb is above 55°F) Procedures for determining Refrigerant Charge using the Standard Charge Measurement Procedure are available in Reference Residential Appendix RA3.2. As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional form(s) for any additional systems in the dwelling as applicable. • The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure. • The system must meet minimum airflow requirements as prerequisite for a valid refrigerant charge test. • If outdoor air dry-bulb is 55°F or below, the installer must use the Alternate Charge Measurement Procedure. Space Conditioning Systems System Name or Identification/Tag System 1 a,(mustbe.re-calibrated monthly) .. Date of Thermocouple Calibration r 1/15/201Z', System Location or Area Served MASTER BED Outdoor Unit Serial # 1110 Outdoor Unit Make AMANA Outdoor Unit Model ASX140601BB Nominal Cooling Capacity Btu/hr 60000 Date of Verification 2/2/2012 Calibration of Diagnostic Instruments Date of Refrigerant Gauge Calibration 4 a,(mustbe.re-calibrated monthly) .. Date of Thermocouple Calibration r 1/15/201Z', (must be re -calibrated monthly) Measured Temperatures (°F) I / } System Name or Identificat on/Tag `,.Asystem, 4 Supply (evaporator leaving) air dry-bulb 56 temperature (Tsupply, db) Return (evaporator entering) air dry-bulb 78 temperature (Treturn, db) Return (evaporator entering) air wet -bulb 57 temperature (Treturn, wb) Evaporator saturation temperature 31 (Tevaporator, sat) Condensor saturation temperature 91 (Tcondensor, sat) Suction line temperature (Tsuction) 50 Liquid Line Temperature (Tliquid) so Condenser (entering) air dry-bulb 7- 75 temperature (Tcondenser, db) [l INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5) Site Address: 50115 ELDORADO DR MASTER BED, La Quinta CA Enforcement Agency: Permit Number: 92253 City of La Quinta 11-1243 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, 22.00 db - Tsupply,db Target Temperature Split from Table RA3.2-3 23.5 using Treturn, wb and Treturn, db Calculate difference: Actual Temperature Split - -1.S 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: Temperature Split Method Calculation is not necessary if actual Cooling Coil Airflow is verified using one of the airflow measurement procedures specified in Reference Residential Appendix RA3.3. If actual cooling coil airflow is measured, the value must be equal to or greater than the Calculated Minimum Airflow Requirement in the table below. Calculated Minimum Airflow Requirement (CFM) = Nominal Cooling Capacity (ton) X 300 (cfm/ton) System Name or Identificatio^cn/Tag/l/ r System 1 �r..'�,r'... ., is .rte' i i•� J `'s X' 'a_.,,e-1.4 s�_ ,,,,,y„rr'., . ri Calculated Minimum AirflowAequirement.(CFM) � � �....�� Vow �{� ✓using Rka , . - A3 - Measured Airfl:3 procedures (CFM) � R'±%w�.Y,.PJ • C.......r...- �.,y.'!,�'.ld:-.;.-..,... ! � '.'_!.!Y'.'+' � Vie!' V '4�. '�-r Passes if measured airflow is greater than or equal to the calculated minimum airflow requirement. Enter Pass or Fail Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for fixed orifice metering device systems System Name or Identification/Tag System 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, INSTALLATION CERTIFICATE CF-6R-MECH-25-HER9 Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5) Site Address: 50115 EL DORADO DR MASTER BED, La Quinta CA Enforcement Agency: Permit Number: 92253 City of La Quinta 11-1243 Subcooling Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag System 1 Calculate: Actual Subcooling = 11.0 Tcondenser, sat - Tliquid Target Subcooling specified by manufacturer 10 Calculate difference: 1 Actual Subcooling - Target Subcooling = System passes if difference is between 401-T rj' "^ -3°F and +3°F PASS Enter Pass or Fail Metering Device Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag System 1 Calculate: Actual Superheat = 19.0 Tsuction - Tevaporator, sat Enter allowable superheat range from manufacturer's specifications (or use range 4-25 between 4°F and 25°F if manufacturer's specification isnot available) „�,¢. ,," 401-T rj' "^ System passes if actual superheat is within -the allowable superheat range PASS Ente� Pass or Fail 7`�� e� .�� '�;�'�'�•�' �� -'��..�^�� = -fes: �Sp � �� i n INSTALLATION CERTIFICATE CF-61R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5) Site Address: 50115 EL DORADO DR MASTER BED, La Quinta CA Enforcement Agency: Permit Number: 92253 City of La Quinta 11-1243 Standard Charge Measurement Summary: System shall pass both refrigerant charge criteria, metering device criteria (if applicable), and minimum cooling coil airflow criteria based on measurements taken concurrently during system operation. If corrective actions were taken, all applicable verification criteria must be re -measured and/or recalculated. System Name or Identification/Tag System 1 CSLB License: Date Signed: Position With Company (Title): System meets all refrigerant charge and airflow 11/20/2011 Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): requirements. PASS Enter Pass or Fail �. 4 DECLARATION STATEMENT • I certify under penalty of perjury, under the laws of the State of California, the Information provided on this form is true and correct. • I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized representative of the person responsible for construction (responsible person). • I certify that the Installed features, materials, components, or manufactured devices identified on this certificate (the Installation) conforms to all applicable codes and regulations, and the installation Is consistent with the plans and specifications approved by the enforcement agency. • I understand that a HERS rater will check the installation to verify compliance, and that that If such checking identifies defects, I am required to take corrective action at my expense. I understand that Energy Commission and HERS provider representatives will also perform quality assurance checking of installations, including those approved as part of a sample group but not checked by a HERS rater, and If those installations fall to meet the requirements of such quality assurance checking, the required corrective action and additional checking/testing of other Installations in that HERS sample group will be performed at my expense. • I reviewed a copy of the Certificate of Compliance (CF -111) form approved by the enforcement agency that Identifies the specific requirements for the installation. I certify that the requirements detailed on the CF -111 that apply to the installation have been met. • I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be Included with the documentation the builder provides to the building owner at occupancy. I will ensure that all Installation Certificates will come from a HERS provider data reqistry for multiple orientation altematives, and beginning October 1, 2010, for all low-rise residential buildings. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) 3 ANTHONY PLUMI3ING HEATING & AIR CONDITIONING Responsible Person's Name: Responsible Person's Signature: Kevin Robinson Kevin Robinson CSLB License: Date Signed: Position With Company (Title): 777794 11/20/2011 Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? 0 Yes p No INSTALLATION CERTIFICATE CF-6R-MECH-04 Space Conditioning Systems, Ducts and Fans (Page 1 of 2) Site Address: 50115 EL DORADO DR MASTER BED, La Quinta CA 92253 Enforcement Agency: Permit Number: (System 1) City of La Quinta 11-1243 Space Conditioning Systems Heating Equipment Equip Type (package- heat pump) CEC Certified Mfr. Name and Model Number ARI Reference Number2 # of Identical Systems Efficiency (AFUE, etc.)1, 3 (>=CF -1R value)4 Duct Location (attic, crawl- space, etc.) Duct R -value Heating Load (kBtu/hr) Heating Capacity (kBtu/hr) Split Furnace AMANA ARI Reference Number2 1 80 AFUE Attic R-6 Cooling Load (kBtu/hr) Cooling Capacity (kBtu/hr) Split � A/C "r �" " ";6 AMANA ,�j F / �' f. t _ � j14 SEM t ti 12 EERil Attic ; t" � R-6' r' Cooling Equipment 1. If project is new construction, see Footnotes to Standards Table 151-B and Table 151-C for duct ceiling alternative compliance. 2. ARI Reference Number can be found by entering the equipment model number at http://www. aridirectory. orgjari/ac. php# 3. Listed efficiency on this page must be greater than or equal ( ? ) to the value shown on the CF -IR form. 4. When CF -1R is reference it is also applicable to the CF -1R, CF -IR -AA or CF -IR -ALT ALL BOXES MUST BE CHECKED TO BE A VALID FORM © §110-§113: HVAC equipment is certified by the California Energy Commission. • §150(h): Heating and/or cooling loads calculated in accordance with ASHRAE, SMACNA, or ACCA. 0 §1S0(i): Setback Thermostat on all applicable heating and/or cooling systems meet the requirements of §112(c). 0 §150(j)2: Pipe insulation for cooling system refrigerant suction, chilled water and brine lines meets minimum requirements of Table 150-B and includes a vapor retardant or is enclosed entirely in conditioned space. U0 Efflclency Duct Equip Type (package heat pump) CEC Certified Mfr. Name and Model Number ARI Reference Number2 # of Identical Systems (SEER and EER) 1, 3 (>=CF -IR value)4 Location (attic, crawl- space, etc.) Duct R -value Cooling Load (kBtu/hr) Cooling Capacity (kBtu/hr) Split � A/C "r �" " ";6 AMANA ,�j F / �' f. t _ � j14 SEM t ti 12 EERil Attic ; t" � R-6' r' 1. If project is new construction, see Footnotes to Standards Table 151-B and Table 151-C for duct ceiling alternative compliance. 2. ARI Reference Number can be found by entering the equipment model number at http://www. aridirectory. orgjari/ac. php# 3. Listed efficiency on this page must be greater than or equal ( ? ) to the value shown on the CF -IR form. 4. When CF -1R is reference it is also applicable to the CF -1R, CF -IR -AA or CF -IR -ALT ALL BOXES MUST BE CHECKED TO BE A VALID FORM © §110-§113: HVAC equipment is certified by the California Energy Commission. • §150(h): Heating and/or cooling loads calculated in accordance with ASHRAE, SMACNA, or ACCA. 0 §1S0(i): Setback Thermostat on all applicable heating and/or cooling systems meet the requirements of §112(c). 0 §150(j)2: Pipe insulation for cooling system refrigerant suction, chilled water and brine lines meets minimum requirements of Table 150-B and includes a vapor retardant or is enclosed entirely in conditioned space. U0 INSTALLATION CERTIFICATE CF-6R-MECH-04 Space Conditioning Systems, Ducts and Fans (Page 2 of 2) Site Address: 50115 EL DORADO DR MASTER BED, La Quinta CA 92253 Enforcement Agency: Permit Number: (System 1) City of La Quinta 11-1243 Ducts and Fans §150(m): Duct and Fans 0 1. All air -distribution system ducts and plenums installed, sealed and insulated to meet the requirements of CMC Sections 601, 602, 603, 604, 605 and Standard 6-5; supply -air and return -air ducts and plenums are insulated to a minimum installed level of R-4.2 or enclosed entirely in conditioned space. Openings shall be sealed with mastic, tape or other duct -closure system that meets the applicable requirements of UL 181, UL 181A, or UL 181B or aerosol sealant that meets the requirements of UL 723. If mastic or tape is used to seal openings greater than 1/4 inch, the combination of mastic and either mesh or tape shall be used; and 0 1. Building cavities, support platforms for air handlers, and plenums defined or constructed with materials other than sealed sheet metal, duct board or flexible duct shall not be used for conveying conditioned air. Building cavities and support platforms may contain ducts. Ducts installed in cavities and support platforms shall not be compressed to cause reductions in the cross-sectional area of the ducts. 0 2D. Joints and seams of duct systems and their components shall not be sealed with cloth back rubber adhesive duct tapes unless such tape is used in combination with mastic and draw bands. 0 7. Exhaust fan systems have back draft or automatic dampers. 0 8. Gravity ventilating systems serving conditioned space have either automatic or readily accessible, manually operated dampers. 0 Protection of Insulation. Insulation shall be protected from damage, including that due to sunlight, moisture, equipment maintenance, and wind. Cellular foam insulation shall be protected as above or painted with a coating that is water retardant and provides shielding from solar radiation that can cause degradation of the material. 0 10. Flexible ducts cannot have porous inner cores.._ _ .- ,� r, ,, ,, f« 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 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. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) 3 ANTHONY PLUMBING HEATING & AIR CONDITIONING Responsible Person's Name: Responsible Person's Signature: Kevin Robinson Kevin Robinson CSLB License: Date Signed: Position With Company (Title): 777794 11/20/2011 Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -1R -ALT -HVAC Climate Zones 10 - 15 Site Address: Enforcement Agency: Date: Permit 50115 EL DORADO DR. LIVING ROOM La Quinta, CA 92253 City of La Quinta Feb 2, 2012 Duct insulation Conditioned Floor Equipment Type1 List Minimum Efficiency2 requirement Area Thermostat ❑ Package Unit 0 Furnace 0 AFUE 78% ❑ COP ❑ R 6 (CZ 10-13) Served by system 0 Setback 0 Indoor Coil 0 SEER 14.0 ❑ HSPF ❑ R g( CZ 14-15) 4500 sf If not already present, must be 0 Condensing Unit [3 EER E3 Resistance installed) ❑ Other 1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -IR -ALT -HVAC for each system. 2. Minimum Equipment Efficiencies: 13 SEER, 78% AFUE, 7.7HSPF for typical residential systems. HERS VERIFICATION SUMMARY Listed below are FOUR HVAC alteration Options. The installer decides what work is being done and picks one of the appropriate Options. Each Option lists the HERS measures that must be conducted. A copy of the forms shall be left on site for final inspection and a copy given to the homeowner. At final, the inspector verifies that the work listed on this form was in fad the work completed by the installer. The inspector also verifies that each appropriate CF -6R and registered CF -4R forms (no hand filled CF-4Rs allowed) are filled out and signed.Beginning October 1, 2010, a registered copy of the CF -1111 and CF -6R shall also be on site for final inspection. 0 1. HVAC Changeout Required Forms: . All HVAC Equipment CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS replaced CF -4R forms: MECH-21 111 Wand (for split systems) MECH-25 . Condenser Coil and /or . Indoor Coil and /or CF -611 forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS . Furnace CF -4R forms: MECH-21 and (for split systems) MECH-25 For Split Systems: Dud leakage < 15 percent; RC, CCA <_ 300 CFM/ton (Minimum Air Flow Requirement), TMAH For- Paekaoed- Un"Its, leakage -; 15 peFeeAt Exempted from dud leakage testing if: ❑ 1. Duct system was documented to have been previously sealed and confirmed through HERS verification, or ❑ 2. Duct systems with less than 40 linear feet in unconditioned space, or ❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos ❑ 4. The.system,will not be Ducted (ie„Ductless.Mini-Split System),(Also Exempt. from;Refrigerant Charge) ❑ 2. New HVAC System Required Forms: ! . Cut inlorChangeout with' new ducts: (all new. - ' �f '11 1 4. �; V, . CF -6R forms. MECH-04, MECH=20=HERS; and'(for split systS ,. ems) MECH=22=HERS, and t dulling and all new MECH=25=HERS R forms: MECH 20, and (for split systems) MECH-22, and MECH-25 r equipment) "�! t. 7-/; / J, i ` J % i_,tip 4, f .�`. - i, yF J a .1 i .L r^ ... r, r For Split Systems: Duct leakage < 6 percent; RC, CCA >_ 350 CFM/ton, FWD,'TMAH, STMS, and either HSPP or PSPP. For Packaged Units: Duct leakage < 6 percent ❑ 3. New Ducts with/or without Required Forms: Replacement . Includes replacing or installing all new ducting and/or outdoor condensing unit CF -6R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS and/or indoor coil and/or furnace. No or some CF -4R forms: MECH-20 and (for split systems) MECH-25 equipment changed. For Split Systems: Dud leakage < 6 percent; RC, CCA >_ 300 CFM/ton, TMAH For Packaged Units: Dud leakage < 6 percent ❑ 4. New Ducting over 40 feet Required Forms: . Includes adding or replacing more than 40 CF -6R forms: MECH-04, MECH-2I-HERS linear feet of dud in unconditioned space. CF -411 forms: MECH-21 For split system or packaged units: Duct leakage < 15 percent ❑ EXCEPTION: Existing dud systems constructed, insulated or sealed with asbestos. Contractor (Documentation Author's /Responsible Designer's Declaration Statement) . I certify that this Certificate of Compliance documentation is accurate and complete. . I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design Identified on this Certificate of Compliance. . I certify that the energy features and performance specifications for the design Identified on this Certificate of Compliance conform to the requirements of Title 24, Parts 1 and 6 of the California Code of Regulations. . The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with the permit application. Name: Kevin Robinson Signature: Kevin Robinson Company: I ANTHONY PLUMBING HEATING & AIR CONDITIONING Date: Feb 1, 2012 Address: 72216 NORTH SHORE ST #101 License: 777794 City/State/Zip: THOUSAND PALMS / CA / 92276 Phone: (760) 328-8096 INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS Duct Leakage Test — Existing Duct System (Page 1 of 2) Site Address: 50115 EL DORADO DR. LIVING ROOM, La Quinta CA 92253 Enforcement Agency; Permit Number: (System 1) City of La Quinta 11-1243 Enter the Duct System Name or Identification/Tag: System 1 Enter the Duct System Location or Area Served: Whole House Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the dwelling. This installation certificate is required for compliance for alterations and additions in existing dwellings to space conditioning systems and duct systems. Note: For existing dwellings, a completely new or replacement duct system can also include existing parts of the original duct system (e.g., register boots, air handler, coil, plenums, etc.) if those parts are accessible and they can be sealed. For a completely new or replacement duct system installed in an existing dwelling, use the Installation Certificate titled "Duct Leakage Test - Completely New or Replacement Duct System. " Duct Leakaae Diaqnostic 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 outside less than 10% of Fan Flow p 3. Reduce leakage by 60% and conduct smoke and fix all leaks 4. Fix all accessible leaks using smoke and HERS rater verify Note: (One of Options 1, 2 or 3 must be attempted before utilizing, Option 4.) Determine nominal Fan" Flow using one of:tbe following three calculation methods. 1 ✓ ® Cooling system method: Size of,condeuser in Tons i 3.5 x 400 ,_ 1400 CFM,' ✓ ❑ Heating system method: 21.7 x _Output Capacity inThousands of Btu/hr = CFM VO airflow n test Measured sStem us RA3.3 airflow rocedures:.� CFM Y 9' p Option i used then: 1 Allowed leakage = Fan Airflow 1400 x 0.15 = 210 CFM Actual Leakage= 110 CFM Pass if Actual Leakage is less than Allowed leakage Pass Fail Option 2 used then: 2 Allowed leakage = Fan Airflow _ x 0.10 = _ CFM Actual Leakage to outside = _ CFM Pass if Actual leakage to outside is less than Allowed leakage Pass Cl 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 reductionCFM ((Leakage reduction _ / Initial leakage _� x 100% _ /6 Reduction Pass if % Reduction > 60% p Pass p Fail Option 4 used then: 4 All accessible leaks repaired using smoke test. HERS rater must verify (No Sampling). Pass if all accessible leaks have been repaired using smoke p Pass 0 Fail I Reg: 212-A0005655B-M2100001A-0000 Registration Date/Time: 2012/02/02 19:15:31 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: 50115 ELDORADO DR. LIVING ROOM, La Quinta CA 92253 Enforcement Agency: Permit Number: (System 1) City of La Quinta 11-1243 ® 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. m All supply;and return register'bootsrmust be,.sealed to the drywall if;smoke test is utilized for compliance - applies to duct le6kage compliance option 3 (leakage reduction by 60%) and option 4;(fix all accessible leaks) described above" k 0 New duct installations cannot utilize building cavities asiplenums or.platform returns in lieu.of ducts 0 Mastic and draw bands must be used' in combination with cloth backed rubber adhesive duct tape to seal leaks at all new duct connections DECLARATION STATEMENT . I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. • I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized representative of the person responsible for construction (responsible person). . I certify that the installed features, materials, components, or manufactured devices Identified on this certificate (the Installation) conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the enforcement agency. • I understand that a HERS rater will check the installation to verify compliance, and that that if such checking identifies defects, I am required to take corrective action at my expense. I understand that Energy Commission and HERS provider representatives will also perform quality assurance checking of installations, including those approved as part of a sample group but not checked by a HERS rater, and if those installations fail to meet the requirements of such quality assurance checking, the required corrective action and additional checking/testing of other installations in that HERS sample group will be performed at my expense. . I reviewed a copy of the Certificate of Compliance (CF -111) form approved by the enforcement agency that identifies the specific requirements for the Installation. I certify that the requirements detailed on the CF -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) 3 ANTHONY PLUMBING HEATING R AIR CONDITIONING Responsible Person's Name: Responsible Person's Signature: Kevin Robinson Kevin Robinson CSLB License:Date Signed: Position With Company (Title): 777794 il/2Q/2Q11 Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? ❑ Yes ❑ No Reg: 212-A0005655B-M2100001A-0000 Registration Date/Time: 2012/02/02 19:15:31 HERS Provider: CaICERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE* CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of S) Site Address: Whole House 1 50115 ELDORADO DR. LIVING ROOM, La Quinta CA Enforcement Agency: Permit Number: 92253 City of La Quinta 11-1243 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 SuDDIv and Return Plenums of Air Handler System Name or Identification/Tag System 1 System Location or Area Served Whole House 1 0 Yes ❑ No 5/16 inch (8 mm) access hole upstream of evaporative coil in the return plenum and labeled according to Figure in Section RA3.2.2.2.2. 2 0 Yes ❑ No 5/16 inch (8 mm) access hole downstream of evaporative coil in the supply plenum and labeled according to Figure in Section RA3.2.2.2.2. Yes to 1 and 2 is a pass. Enter Pass or Faill ✓ ® Pass ✓ ❑ Fail STMS - Sensor on the Evaporator,'Coil System Name or Identification/Tag.- System 1 r . ! The sensor is factory installed, or, field installed according to manufacturer's 3 ❑ Yes r- p No r • specifications, or is installed by methods/specifications approved,by the Executive ` Director. ,t i The sensor wire is terminated with standard mini plug suitable for connection -to a 4 ❑ 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 5 1 ❑ Yes ❑ No The sensor measures the saturation temperature of the coil within 1.3 degrees F Yes to 3, 4, and 5 is a pass. Enter N/A if STMS are not ✓ D N/A ✓ [3 Pass ✓ ❑Fail applicable. Otherwise enter Pass or Fail STMS - Sensor on the Condenser Coil System Name or Identification/Tag I 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 1 ❑ Yes I ❑ 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 ✓ ® N/A ✓ ❑ Pass ✓ ❑ Fail applicable. Otherwise enter Pass or Fail Reg: 212-A0005655B-M2500001A-0000 Registration Date/Time: 2012/02/02 19:28:47 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5) Site Address: 50115 ELDORADO DR. LIVING ROOM, La Quinta CA Enforcement Agency: Permit Number: 92253 City of La Quinta 11-1243 Standard Charge Measurement Procedure (for use if outdoor air dry-bulb is above 55°F) Procedures for determining Refrigerant Charge using the Standard Charge Measurement Procedure are available In Reference Residential Appendix RA3.2. As many as 4 systems In the dwelling can be documented for compliance using this form. Attach an additional form(s) for any additional systems in the dwelling as applicable. • The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure. • The system must meet minimum airflow requirements as prerequisite for a valid refrigerant charge test. • If outdoor air dry-bulb is 55°F or below, the installer must use the Alternate Charge Measurement Procedure. Space Conditioning Systems System Name or Identification/Tag System 1 �,, (must, be re -calibrated monthly) � is 1 /' Date of Thermocouple Calibration ► a . �. X1%15/2011, System Location or Area Served Whole House r Outdoor Unit Serial # 1104193329 Outdoor Unit Make AMANA Outdoor Unit Model ASX140601SO Nominal Cooling Capacity Btu/hr 60000 Date of Verification 2/2/2012 uanorauon or uiagnosac tnsuumenrs Date of Refrigerant Gauge Calibration 1/15/2012. �,, (must, be re -calibrated monthly) � is 1 /' Date of Thermocouple Calibration ► a . �. X1%15/2011, ,.. gYrs (must be re -'cal ibrated monthly) r measurea,iemperatures t -r1 Fit, i tt 111 r T 1-3 A �f 1 N 4 - ,- .-% rC% �Wft ♦r - System Name or,Identifitation/Tag�` System i a. -x r Supply (evaporator leaving) air dry-bulb 57 temperature (Tsupply, db) Return (evaporator entering) air dry-bulb 78 temperature (Treturn, db) Return (evaporator entering) air wet -bulb 57 temperature (Treturn, wb) Evaporator saturation temperature 37 (Tevaporator, sat) Condensor saturation temperature 90 (Tcondensor, sat) Suction line temperature (Tsuction) 53 Liquid Line Temperature (Tliquid) 81 Condenser (entering) air dry-bulb 75 temperature (Tcondenser, db) Reg: 212-A0005655B-M2500001A-0000 Registration Date/Time: 2012/02/02 19:28:47 HERS Provider: Ca10ERTS, 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: 50115 ELDORADO DR. LIVING ROOM, La Quinta CA Enforcement Agency: Permit Number: 92253 City of La Quinta 11-1243 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 23.5 using Treturn, wb and Treturn, db Calculate difference: Actual Temperature Split - -2.5 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: Temperature Split Method Calculation is not necessary if actual Cooling Coil Airflow is verified using one of the airflow measurement procedures specified in Reference Residential Appendix RA3.3. If actual cooling coil airflow is measured, the value must be equal to or greater than the Calculated Minimum Airflow Requirement in the table below. Calculated Minimum Airflow Requirement (CFM) = Nominal Cooling Capacity (ton) X 300 (cfm/ton) System Name or Identification/Tag/� !fr r System i Calculated Minimum Airflow Requirement (CFM) } _ t A J i .f'01. &I I [ ` c A71 Measured Airflo'"w sing RA3:3Fpr edures (CFM) Passes if measured airflow is greater than or equal to the calculated minimum airflow requirement. Enter Pass or Fail Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for fixed orifice metering device systems System Name or Identification/Tag System 1 Calculate: Actual Superheat = Tsuction - Tevaporator, sat Target Superheat from Table RA3.2-2 using Treturn, wb and Tcondenser, db Calculate difference: Actual Superheat - Target Superheat = System passes if difference is between -5°F and +5°F Enter Pass or Fail Reg: 212-A00056558-M2500001A-0000 Registration Date/Time: 2012/02/02 19:28:47 HERS Provider: Ca10ERTS, 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: 50115 ELDORADO DR. LIVING ROOM, La Quinta CA Enforcement Agency: Permit Number: 92253 City of La Quinta 11-1243 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 Identificationirag System 1 Calculate: Actual Subcooling = 9.0 Tcondenser, sat - Tliquid Target Subcooling specified by manufacturer 10 Calculate difference: -1 Actual Subcooling - Target Subcooling = System passes if difference is between N-l"VIV PO "" w -3°F and +3°F PASS # " . s r Enter Pass or Faill ' 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 = 16.0 Tsuction - Tevaporator, sat Enter allowable superheat range from manufacturer's specifications (or use range 4-25 between 4°F and 25°F if manufacturer's specification is!661: available) --t N-l"VIV PO "" w System passes if actual superheat is withimthe allowable"superheat range �nj'. PASS # " . s r EnterrPass or Fail ' �` Reg: 2.12-A0005655B-M2500001A-0000 Registration Date/Time: 2012/02/02 19:28:47 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: 50115 ELDORADO DR. LIVING ROOM, La Quinta CA Enforcement Agency: Permit Number: 92253 City of La Quinta 11-1243 Standard Charge Measurement Summary: System shall pass both refrigerant charge criteria, metering device criteria (if applicable), and minimum cooling coil airflow criteria based on measurements taken concurrently during system operation. If corrective actions were taken, all applicable verification criteria must be re -measured and/or recalculated. System Name or Identification/Tag System 1 CSLB License: Date Signed: Position With Company (Title): System meets all refrigerant charge and airflow 11/20/2011 Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): requirements. PASS Enter Pass or Fail DECLARATION STATEMENT a • I certify under penalty of perjury, under the laws of the State of California, the information provided on this form Is true and correct. • I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized representative of the person responsible for construction (responsible person). • I certify that the installed features, materials, components, or manufactured devices Identified on this certificate (the installation) conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the enforcement agency. I understand that a HERS rater will check the installation to verify compliance, and that that if such checking identifies defects, I am required to take corrective action at my expense. I understand that Energy Commission and HERS provider representatives will also perform quality assurance checking of installations, including those approved as part of a sample group but not checked by a HERS rater, and if those installations fail to meet the requirements of such quality assurance checking, the required corrective action and additional checking/testing of other installations in that HERS sample group will be performed at my expense. . I reviewed a copy of the Certificate of Compliance (CF -111) form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF -111 that apply to the installation have been met. • I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the building permit(s) Issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. I will ensure that all Installation Certificates will come from a HERS provider data registry for multiple orientation alternatives, and beginning October 1, 2010, for all low-rise residential buildings. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) ANTHONY PLUMBING HEATING & AIR CONDITIONING Responsible Person's Name: Responsible Person's Signature: Kevin Robinson Kevin Robinson CSLB License: Date Signed: Position With Company (Title): 777794 11/20/2011 Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? ❑ Yes ❑ No Reg: 212-A0005655B-M2500001A-0000 Registration Date/Time: 2012/02/02 19:28:47 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-04 Space Conditioning Systems, Ducts and Fans (Page 1 of 2) Site Address: 50115 EL DORADO DR. LIVING ROOM, La Quinta CA 92253 Enforcement Agency: Permit Number: (System 1) City of La Quinta 11-1243 Space Conditioning Systems Heating Equipment Equip Type (package- heat pump) CEC Certified Mfr. Name and Model Number ARI Reference Number2 # of Identical Systems Efficiency (AFUE, etc.)1, 3 (>=CF-iR value)4 Duct Location (attic, crawl- space, etc.) Duct R -value Heating Load (kBtu/hr) Heating Capacity (kBtu/hr) Split Furnace AMANA ARI 1 80 AFUE Attic R-6 Cooling Cooling heat pump) CEC Certified Mfr. Name and Model Number Reference Number2 Identical Systems (>=CF -1R value)4 space, etc.) Duct R -value Load (kBtu/hr) Capacity (kBtu/hr) Split A/C „ AMANA / Yx � 11 • r",14 SEERV 12 EERT. Attic f R-6 $ It' 1 sIrA Xs Cooling Equipment Equip Efficiency (SEER Duct Location Type (package ARI # of and EER) 1, 3 (attic, crawl- Cooling Cooling heat pump) CEC Certified Mfr. Name and Model Number Reference Number2 Identical Systems (>=CF -1R value)4 space, etc.) Duct R -value Load (kBtu/hr) Capacity (kBtu/hr) Split A/C „ AMANA / Yx � 11 • r",14 SEERV 12 EERT. Attic f R-6 $ It' 1 sIrA Xs 1. If project is new construction, see Footnotes to Standards Table 151-8 and Table 151-C for duct ceiling alternative compliance. 2. ARI Reference Number can be found by entering the equipment model number at http://www.aridirectory.orglarilac.php# 3. Listed efficiency on this page must be greater than or equal ( ? ) to the value shown on the CF -IR form. 4. When CF -IR is reference it is also applicable to the CF -IR, CF -IR -AA or CF -IR -ALT ALL BOXES MUST BE CHECKED TO BE A VALID FORM 0 §110-§113: HVAC equipment is certified by the California Energy Commission. 0 §150(h): Heating and/or cooling loads calculated in accordance with ASHRAE, SMACNA, or ACCA. 0 §150(i): Setback Thermostat on all applicable heating and/or cooling systems meet the requirements of §112(c). 0 §150(j)2: Pipe insulation for cooling system refrigerant suction, chilled water and brine lines meets minimum requirements of Table 150-B and includes a vapor retardant or is enclosed entirely in conditioned space. Reg: 212-A0005655B-M0400001A-0000 Registration Date/Time: 2012/02/02 19:14:11 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-04 Space Conditioning Systems, Ducts and Fans (Page 2 of 2) Site Address: 50115 EL DORADO DR. LIVING ROOM, La Quinta CA 92253 Enforcement Agency: Permit Number: (System 1) City of La Quinta 11-1243 Ducts and Fans §150(m): Duct and Fans 0 1. All air -distribution system ducts and plenums installed, sealed and insulated to meet the requirements of CMC Sections 601, 602, 603, 604, 605 and Standard 6-5; supply -air and return -air ducts and plenums are insulated to a minimum installed level of R-4.2 or enclosed entirely in conditioned space. Openings shall be sealed with mastic, tape or other duct -closure system that meets the applicable requirements of UL 181, UL 181A, or UL 181B or aerosol sealant that meets the requirements of UL 723. If mastic or tape is used to seal openings greater than 1/4 inch, the combination of mastic and either mesh or tape shall be used; and 0 1. Building cavities, support platforms for air handlers, and plenums defined or constructed with materials other than sealed sheet metal, duct board or flexible duct shall not be used for conveying conditioned air. Building cavities and support platforms may contain ducts. Ducts installed in cavities and support platforms shall not be compressed to cause reductions in the cross-sectional area of the ducts. 0 2D. 3oints and seams of duct systems and their components shall not be sealed with cloth back rubber adhesive duct tapes unless such tape is used in combination with mastic and draw bands. 0 7. Exhaust fan systems have back draft or automatic dampers. 0 8. Gravity ventilating systems serving conditioned space have either automatic or readily accessible, manually operated dampers. 0 Protection of Insulation. Insulation shall be protected from damage, including that due to sunlight, moisture, equipment maintenance, and wind. Cellular foam insulation shall be protected as above or painted with a coating that is water retardant and provides shielding from solar radiation that can cause degradation of the material. 0 10. Flexible -ducts cannot have porous,inner cores._ 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 reviewed a copy of the Certificate of Compliance (CF -IR) form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF -LR that apply to the installation have been met. • I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) 3 ANTHONY PLUMBING HEATING & AIR CONDMONING Responsible Person's Name: Responsible Person's Signature: Kevin Robinson Kevin Robinson CSLB License: Date Signed: Position With Company (Title): 777794 11/20/2011 Reg: 212-A0005655B-M0400001A-0000 Registration Date/Time: 2012/02/02 19:14:11 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms August 2009 Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -IR -ALT -HVAC Climate Zones 10 - 15 Site Address: Enforcement Agency: Date: Permit #: 50115 EL DORADO DR KITCHEN La Quinta, CA 92253 City of La Quinta I Feb 2, 2012 Duct insulation Conditioned Floor Equipment Typel List Minimum Efficiency2 requirement Area Thermostat ❑ Package Unit 0 Furnace 0 Indoor Coil 0 AFUE 78% 0 SEER 14.0 ❑ COP ❑ HSPF ❑ R 6 (CZ 10-13) Served by system 0 Setback If not already present must be 0 Condensing Unit ❑ EER ❑ Resistance ❑ R g CZ 14-15 ) sf 145- installed) ❑ Other 1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -IR -ALT -HVAC for each system. 2. Minimum Equipment Efficiencies: 13 SEER, 78% AFUE, 7.7HSPF for typical residential systems. HERS VERIFICATION SUMMARY Listed below are FOUR HVAC alteration Options. The installer decides what work is being done and picks one of the appropriate Options. Each Option lists the HERS measures that must be conducted. A copy of the forms shall be left on site for final inspection and a copy given to the homeowner. At final, the inspector verifies that the work listed on this form was in fact the work completed by the installer. The inspector also verifies that each appropriate CF -611 and registered CF -411 forms (no hand filled CF-4Rs allowed) are filled out and signed.Beginning October 1, 2010, a registered copy of the CF -1111 and CF -6111 shall also be on site for final inspection. 0 1. HVAC Changeout Required Forms: . All HVAC Equipment CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS replaced CF -4R forms: MECH-21 11 iNOand (for split systems) MECH-25 . Condenser Coil and /or . Indoor Coil and /or CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS . Furnace CF -4R forms: MECH-21 and (for split systems) MECH-25 For Split Systems: Duct leakage < 15 percent; RC, CCA 5 300 CFM/ton (Minimum Air Flow Requirement), TMAH Exempted from dud leakage testing if: ❑ 1. Duct system was documented to have been previously sealed and confirmed through HERS verification, or ❑ 2. Duct systems with less than 40 linear feet in unconditioned space, or ❑ 3. Existing dud systems are constructed, insulated or sealed with asbestos ❑ 4. The system will not be Ducted (ie.,Ductless.Mini-Split System).(Also Exempt:from-Refrigerant Charge) ❑ 2. New HVAC System Required_ Forms: r . Cut inior.Changeout with;f CF -6R forms:'MECH-04 M9.-20*HERS sand°(for split systems) MECH-22-HERS, and new ducts: (all new ducting and- all new ' MECH-25=HERS -' i � CF -4R forms: MECH 20, and`(for split systems') MECH-22;,and MECH-25 equipment) ,.� _ /J Ue� For Split Systems: Dud leakage <,6 percent; RC, CCA -2! 350 CFM/ton, FWD, TMAH, STMS, and either HSPP or PSPP. For Packaged Units: Duct leakage < 6 percent ❑ 3. New Ducts with/or without Required Forms: Replacement .Includes replacing orinstalling all new ducting and/or outdoor condensing unit CF -6R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS and/or indoor coil and/or furnace. No or some CF -411 forms: MECH-20 and (for split systems) MECH-25 equipment changed. For Split Systems: Duct leakage < 6 percent; RC, CCA >_ 300 CFM/ton, TMAH For Packaged Units: Duct leakage < 6 percent ❑ 4. New Ducting over 40 feet Required Forms: . Includes adding or replacing more than 40 CF -6R forms: MECH-04, MECH-2I-HERS linear feet of duct in unconditioned space. CF -4R forms: MECH-21 For split system or packaged units: Duct leakage < 15 percent ❑ EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos. Contractor (Documentation Author's /Responsible Designer's Declaration Statement) . I certify that this Certificate of Compliance documentation is accurate and complete. . I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of Compliance. . I certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24, Parts 1 and 6 of the California Code of Regulations. . The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with the permit application. Name: Signature: Company: I ANTHONY PLUMBING HEATING & AIR CONDITIONING Date: Nov 17, 2011 Address: 72216 NORTH SHORE ST #101 License: 777794 City/State/Zip: THOUSAND PALMS / CA / 92276 Phone: (760) 328-8096 Reg: 211-A0059944B-00000000-0000 Registration Date/Time: 2011/11/17 12:58:44 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms July 2010 INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS Duct Leakage Test — Existing Duct System (Page 1 of 2) Site Address: 50115 ELDORADO DR KITCHEN, La Quinta CA 92253 Enforcement Agency: Permit Number: (System 1) City of La Quinta 11-1243 Enter the Duct System Name or Identification/Tag: System 1 Enter the Duct System Location or Area Served: Whole House Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the dwelling. This installation certificate is required for compliance for alterations and additions in existing dwellings to I `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 0 3. Reduce leakage by 60% and conduct smoke and fix all leaks ❑ 4. Fix all accessible leaks using smoke and HERS rater verify Note: (One of Options 1, 2 or 3 must be attempted before utilizing Option 4.) Determine nominal Fan Flow using one of the following three calculation methods. ✓ Cooling system method: Size of condenser in Tons 5 _ x 400 = 2000 CFM ✓ Heating system method: 21.7 x + Output Capacity in Thousands of Btu/hr = CFM ✓ 0 Measured system airflow using RA3.3 airflow test procedures: _ CFM Option 1 used then: 1 Allowed leakage = Fan Airflow 2000 x 0.15 = 300 CFM Actual Leakage = 108 CFM Pass if Actual Leakage is less than Allowed leakage M Pass Fail Option 2 used then: 2 Allowed leakage = Fan Airflow _ x 0.10 = _ CFM Actual Leakage to outside = _ CFM Pass if Actual leakage to outside is less than Allowed leakage Pass Q Fail Option 3 used then: Initial leakage prior to start of work = _ CFM Final leakage after sealing all accessible leaks using smoke test = _ CFM 3 Initial leakage _ - Final leakage _ = Leakage reduction _ CFM ((Leakage reduction _ / Initial leakage _) x 100% _ % Reduction Pass if % Reduction > 600/a 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 Pass Fail Reg: 211-A0059944B-M2100001A-0000 Registration Date/Time: 2012/02/02 20:17:55 HERS Provider: Ca10ERTS, 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: 50115 EL DORADO DR KITCHEN, La Quinta CA 92253 Enforcement Agency: Permit Number: (System 1) City of La Quinta 11-1243 0 Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off during duct leakage testing. CFI OA ducts that utilize controlled motorized dampers, that open only when OA ventilation is required to meet ASHRAE Standard 62.2, and close when OA ventilation is not required, may be configured to the closed position during duct leakage testing. 0 All supply and return register'boots must be sealed to the drywall if smoke test is utilized for compliance - applies to duct leakage compliance option 3 (leakage reduction by 50%) and option 4 (fix all'accessible leaks) described above. a . 0 New duct installations cannot utilize building cavities as -plenums or platform returns in lieu of ducts. . 0 Mastic and draw bands must be used in combination with cloth backed rubber adhesive duct tape to seal leaks at all new duct connections DECLARATION STATEMENT • I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct, • I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized representative of the person responsible for construction (responsible person). • I certify that the installed features, materials, components, or manufactured devices identified on this certificate (the installation) conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the enforcement agency. • I understand that a HERS rater will check the installation to verify compliance, and that that if such checking identifies defects, I am required to take corrective action at my expense. I understand that Energy Commission and HERS provider representatives will also perform quality assurance checking of installations, including those approved as part of a sample group but not checked by a HERS rater, and if those installations fail to meet the requirements of such quality assurance checking, the required corrective action and additional checking/testing of other installations in that HERS sample group will be performed at my expense. • I reviewed a copy of the Certificate of Compliance (CF -111) form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF -SR that apply to the installation have been met. • I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. I will ensure that all Installation Certificates will come from a HERS provider data registry for multiple orientation alternatives, and beginning October 1, 2010, for all low-rise residential buildings. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) J ANTHONY PLUMBING HEATING & AIR CONDITIONING Responsible Person's Name: Responsible Person's Signature: Kevin Robinson Kevin Robinson CSLB License: 777794 Date Signed: 11/20/2011 Position With Company (Title): Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? 0 Yes ❑ No 7771 Reg: 2.11-A00599448-M2100001A-0000 Registration Date/Time: 2012/02/02 20:17:55 HERS Provider: CaICERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-6R-MECH-0 Space Conditioning Systems, Ducts and Fans (Page 1 of 2) Site Address: 50115 EL DORADO DR KITCHEN, La Quinta CA 92253 Enforcement Agency: Permit Number: (System 1) City of La Quinta 11-1243 Space Conditioning Systems Heating Equipment Equip Type (package- heat pump) CEC Certified Mfr. Name and Model Number ARI Reference Number2 # of Identical Systems Efficiency (AFUE, etc.)1, 3 (>=CF -1R value)4 Duct Location (attic, crawl- space, etc.) Duct R -value Heating Load (kBtu/hr) Heating Capacity (kBtu/hr) Split Furnace AMANA 1 80 AFUE Attic ` R-6 Cooling Equipment Equip Type (package heat pump) CEC Certified Mfr. Name and Model Number ARI Reference Number2 # of Identical Systems Efficiency (SEER and EER) 1, 3 (>=CF -1R value)4 Duct Location (attic, crawl- space, etc.) Duct R -value Cooling Load (kBtu/hr) Cooling Capacity (kBtu/hr) Split A/C AMANA 1 14 SEER 12 EER Attic ` R-6 1. If project is new construction, see Footnotes to Standards Table 151-B and Table 151-C for duct ceiling alternative compliance. 2. ARI Reference Number can be found by entering the equipment model number at http://www.aridirectory.orglarilac.php# 3. Listed efficiency on this page must be greater than or equal ( ? ) to the value shown on the CF -IR form. 4. When CF -IR is reference it is also applicable to the CF -IR, CF -IR -AA or CF -IR -ALT ALL BOXES MUST BE CHECKED TO BE A VALID FORM 2 §110-§113: HVAC equipment is certified by the California Energy Commission. ® §150(h): Heating and/or cooling loads calculated in accordance with ASHRAE, SMACNA, or ACCA. 0 §150(1): Setback Thermostat on all applicable heating and/or cooling systems meet the requirements of §112(c). 0 §150(j)2: Pipe insulation for cooling system refrigerant suction, chilled water and brine lines meets minimum requirements of Table 150-B and includes a vapor retardant or is enclosed entirely in conditioned space. Reg: 211-A0059944B-M0400001A-0000 Registration Date/Time: 2012/02/02 20:17:05 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-04 Space Conditioning Systems, Ducts and Fans (Page 2 of 2) Site Address: 50115 EL DORADO DR KITCHEN, La Quinta CA 92253 Enforcement Agency: Permit Number: (System 1) City of La Quints 11-1243 Ducts and Fans §150(m): Duct and Fans 0 1. All air -distribution system ducts and plenums installed, sealed and insulated to meet the requirements of CMC Sections 601, 602, 603, 604, 605 and Standard 6-5; supply -air and return -air ducts and plenums are insulated to a minimum installed level of R-4.2 or enclosed entirely in conditioned space. Openings shall be sealed with mastic, tape or other duct -closure system that meets the applicable requirements of UL 181, UL 181A, or UL 181B or aerosol sealant that meets the requirements of UL 723. If mastic or tape is used to seal openings greater than 1/4 inch, the combination of mastic and either mesh or tape shall be used; and 0 1. Building cavities, support platforms for air handlers, and plenums defined or constructed with materials other than sealed sheet metal, duct board or flexible duct shall not be used for conveying conditioned air. Building cavities and support platforms may contain ducts. Ducts installed in cavities and support platforms shall not be compressed to cause reductions in the cross-sectional area of the ducts. 0 2D. Joints and seams of duct systems and their components shall not be sealed with cloth back rubber adhesive duct tapes unless such tape is used in combination with mastic and draw bands. 0 7. Exhaust fan systems have back draft or automatic dampers. 0 8. Gravity ventilating systems serving conditioned space have either automatic or readily accessible, manually operated dampers. 0 Protection of Insulation. Insulation shall be protected from damage, including that due to sunlight, moisture, equipment maintenance, and wind. Cellular foam insulation shall be protected as above or painted with a coating that is water retardant and provides shielding from solar radiation that can cause degradation of the material. 0 10. Flexible ducts cannot have porous. inner.cores. 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 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. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) 3 ANTHONY PLUMBING HEATING & AIR CONDITIONING Responsible Person's Name: Responsible Person's Signature: Kevin Robinson Kevin Robinson CSLB License: Date Signed: Position With Company (Title): 777794 11/20/2011 Reg: 211-A0059944B-MO400001A-0000 Registration Date/Time: 2012/02/02 20:17:05 HERS Provider: CalCERTS, Iric. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE* CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 5) Site Address: I Enforcement Agency: Permit Number: 50115 EL DORADO DR KITCHEN, La Quinta CA 92221 City of La Quinta 11-1243 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 Supplv and Return Plenums of Air Handler System Name or Identification/Tag System 1 System Location or Area Served Whole House 1 p Yes ❑ No 5/16 inch (8 mm) access hole upstream of evaporative coil in the return plenum and labeled according to Figure in Section RA3.2.2.2.2. 2 p Yes ❑ No 5/16 inch (8 mm) access hole downstream of evaporative coil in the supply plenum and labeled according to Figure in Section RA3.2.2.2.2. Yes to 1 and 2 is a pass. Enter Pass or Faill ✓ 2 Pass ✓ ❑ Fail STMS - Sensor on the Evaporator Coil System Name or Identification/Tag System 1 The sensor is factory installed, or field installed according to manufacturer's 3 ❑ 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 4 ❑ 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 5 ❑ Yes I ❑ No IThe sensor measures the saturation temperature of the coil within 1.3 degrees F Yesto 3, 4, and 5 is a pass. Enter N/A if STMS are not✓ 2 N/A ✓ ❑ Pass ✓ ❑ Fail applicable. Otherwise enter Pass or Fail STMS - Sensor on the Condenser Coil System Name or Identification/Tag I 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 1.3 degrees F Yes to 6, 7, and 8 is a pass. Enter N/A if STMS are not ✓ 0 N/A ✓ ❑ Pass _17❑ Fail applicable. Otherwise enter Pass or Fail Reg: 211-A0059999B-M2500001A-0000 Registration Date/Time: 2012/02/02 20:23:50 HERS Provider: CalCERTS, Inc. 2008 Residential compliance Forms August 2009 INSTALLATION CERTIFICATE CF-611-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 51 Site Address: I Enforcement Agency: Permit Number: 50115 EL DORADO DR KITCHEN, La Quinta CA 92253 City of La Quinta 11-1243 Standard Charge Measurement Procedure (for use if outdoor air dry-bulb is above 55°F) Procedures for determining Refrigerant Charge using the Standard Charge Measurement Procedure are available in Reference Residential Appendix RA3.2. As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional form(s) for any additional systems in the dwelling as applicable. • The system should be Installed and charged in accordance with the manufacturer's specifications before starting this procedure. • The system must meet minimum airflow requirements as prerequisite for a valid refrigerant charge test. • If outdoor air dry-bulb is 55°F or below, the installer must use the Alternate Charge Measurement Procedure. Space Conditioning Systems System Name or Identification/Tag System 1 (must be re -calibrated monthly) Date of Thermocouple Calibration / 1/15/2012 i System Location or Area Served Whole House Outdoor Unit Serial # 1110546890 •-� - "' --�` �- Outdoor Unit Make AMANA Outdoor Unit Model ASX140601BO Nominal Cooling Capacity Btu/hr 60000 Date of Verification 2/2/2012 caiioration of oreonostic instruments Date of Refrigerant Gauge Calibration 1/15/2012 (must be re -calibrated monthly) Date of Thermocouple Calibration / 1/15/2012 i (must be re' ted monthly) measurea iemoeratures t.,rl , j ._. 1 _4 -- System Name or Identification/Tag s System 1 �• t } �� Supply (evaporator leaving) air dry-bulb - 55 •-� - "' --�` �- temperature (T ) supply, db Return (evaporator entering) air dry-bulb �� temperature (Treturn, db) Return (evaporator entering) air wet -bulb 57 temperature (Treturn, wb) Evaporator saturation temperature 33 (Tevaporator, sat) Condensor saturation temperature 89 (Tcondensor, sat) Suction line temperature (Tsuction) 40 Liquid Line Temperature (Tliquid) 81 Condenser (entering) air dry-bulb 75 temperature (Tcondenser, db) Reg: 211-A0059944B-M2500001A-0000 Registration Date/Time: 2012/02/02 20:23:50 HERS Provider: CaICERTS, 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: 50115 EL DORADO DR KITCHEN, La Quinta CA 92253 City of La Quinta 11-1243 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, 22.00 db - Tsupply, db Target Temperature Split from Table RA3.2-3 23.5 using Treturn, wb and Treturn, db Calculate difference: Actual Temperature Split - -1.5 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: Temperature Split Method Calculation is not necessary if actual Cooling Coil Airflow is verified using one of the airflow measurement procedures specified in Reference Residential Appendix RA3.3. If actual cooling coil airflow is measured, the value must be equal to or greater than the Calculated Minimum Airflow Requirement in the table below. Calculated Minimum Airflow Requirement (CFM) = Nominal Cooling Capacity (ton) X 300 (cfm/ton) System Name or Identification/Tag f System 1 t Calculated Minimum Airflow Requirement (CFM) Measured Airflow using RA3.3 procedures (CFM) Passes if measured airflow is greater than or equal to the calculated minimum airflow requirement. Enter Pass or Fail Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for fixed orifice metering device systems System Name or Identification/Tag System 1 Calculate: Actual Superheat = Tsuction - Tevaporator, sat Target Superheat from Table RA3.2-2 using Treturn, wb and Tcondenser, db Calculate difference: Actual Superheat - Target Superheat = System passes if difference is between -5°F and +5°F Enter Pass or Fail Reg: 211-AO059999B-M2500001A-0000 Registration Date/Time: 2012/02/02 20:23:50 HERS Provider: CalCERTS, 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: I Enforcement Agency: Permit Number: 50115 EL DORADO DR KITCHEN, La Quinta CA 92253 City of La Quinta 11-1243 Subcooling Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag System 1 Calculate: Actual Subcooling = 8.0 Tcondenser, sat - Tliquid Target Subcooling specified by manufacturer 10 Calculate difference: -2 Actual Subcooling - Target Subcooling = System passes if difference is between -30F and +30F PASS Enter Pass or Fail x' PASS i 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 = 7.0 Tsuction - Tevaporator, sat Enter allowable superheat range from manufacturer's specifications (or use range 4-25 between 4°F and 25°F if manufacturer's specification is not available) System passes if actual superheat is within the allowable superheat range J ` ._ ;" x' PASS i y. Enter Pass or Fail Reg: 211-A0059944B-M2500001A-0000 Registration Date/Time: 2012/02/02 20:23:50 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009