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13-0747 (MECH)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Tiat " (e BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Application Number: 13-00000747 Property Address: 78620 FORBES CIR APN: 604-221-004-40 -23268 Application description: MECHANICAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 8800 Applicant: Architect or Engineer: LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License Class: C20 license No.: 686310 Date: i 13 Contractor: c, �— OWNER -BUILDER DECLARATION - - - I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with -Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500).: (_ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). (_) I,.as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors -State License Law does not -apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State Licens6 Law.). ( 1 I am exempt under Sec. , B.&P.C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: _ Lender's Address: LQPERMIT Owner: PUENTE MARIA L 78620 FORBES CIR LA QUINTA, CA 92253 Contractor: GENERAL AIR CONDITIONING 31170 RESERVE'DRIVE THOUSAND PALMS, CA 92276 (760)343-7488 Lic. No.: 686310 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 6/17/13 ------------------- WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier ZENITH INS CO Policy Number Z071741502 I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 33700 of the Labor Code, I shall forthwith comply with those provisions. Date: Applicant: �'� • ' WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. 1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application, the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents and employees -for any act or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upon the above-mentioned property for inspection purposes. ,pate: 6 17 h Signature (Applicant or Agent): LQPERMIT Application Number .. . . . . 13-00000747 Permit MECHANICAL 2013 Additional desc . . Permit Fee . . . . 71.50 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 Expiration Date 12/14/13 Qty Unit Charge Per Extension 1.00 35.7500 EA MECH FURNACE 35.75 1.00 35.7500 EA MECH CONDENSER/COMP 35.75 ---------------------------------------------------------------------------- Special Notes and Comments HVAC CHANGE OUT - 13SEER/78AFUE SPLIT SYSTEM (2008 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2010 CALIFORNIA BUILDING CODES. June 17, 2013 12:25:16 PM AORTEGA - ------------------------------------------------------------- Other Fees . . . . . . . . BLDG STDS ADMIN (SB1473) -------------- 1.00 PERMIT ISSUANCE M/P/E 90.57 PLAN CHECK, MECHANICAL 47.66 Fee summary Charged Paid Credited Due --------------------------------------------------------- Permit Fee Total 71.50 .00 .00 71.50 Plan Check Total .00 .00 .00 .00 Other Fee Total 139.23 .00 .00 139.23 Grand -Total 210.73 .00 .00- 210.73 Bin # City of La Quinta Building & Safety Wston P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # t3 Project Address: "� �(�� j�or-s C -x Le- Owner's Name: A. P. Number: Address: -786-2-0 . ;;cbes Legal Description: City, ST, Zip: L C.A ct Z253 Contractor: ?:µM4', k...:n^i::•:.: r•i`i'yryi:.r1r%. Telephone: ' ✓ � s:,• .r!y z,r x vi<~;<:;:;: Address: '31k-70 -�t gS clCv a 1. X • Project Description: City, ST, Zip: G1 5 CA g2Z7(. e- `G:t�e .S� mh G Sc� Telephone: State Lic. # : City Lie. #; Arch., Engr., Designer: Address: City,, ST, Zip: vi%~ :'µ>3:'� Yt3a,`r Telephone: ;�;_:;Y<!;s:• '�•: �'; �...`.,+ State Lie. Name of Contact Person: Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo Sq. Ft.: # Stories: it Units.. Telephone # of Contact Person: Estimated Value of Project: g 00 APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Title 24 Calcs. Plans picked up Construction Flood plain plan Pians 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:- ''d Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees INSTALLATION CERTIFICATE CF-611-MECH-2I-HERS Duct Leakage Test — Existing Duct System (Page 1 of 2) Site Address: 78620 FORBES CIRCLE, La Quinta CA 92253 (System Enforcement Agency: Permit Number: 1) City of La Quinta 13-0747 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. Tote: For existing dwellings, a completely new or replacement duct system can also include existing parts o he original duct system (e.g., register boots, air handler, coil, plenums, etc.) if those parts are accessible nd they can be sealed. For a completely new or replacement duct system installed in an existing dwelling, se 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 Fan1iFlow using'one ofm.th,e`following three calculation methods." w° lie ✓ ® Cooling, system method: Size of condenser in Tons 5 - x.400'=, 2000 ✓ ting ,of 8 /hr ❑ He system method: 21.7,x. Output Capacity in Thousands= _ CFM ✓ 11 Measured. a,y system. airflow using`RA3.3 airflowtest procedures:CFM � Option'1 used then: Y,„,;e ;•f„. w ;;...�-. w h 1 Allowed leakage = Fan Airflow 060 x 0.15 300 CFM Actual Leakage= 130 CFM-, Pass if Actual Leakage is less than Allowed leakage _pq Pass ❑ Fail Option 2 used then:,, 2 Allowed leakage = Fan Airflow � x 0.10 = _ CFM Actual Leakage to outside = s CFM Pass if Actual leakage to outside is less than Allowed leakage Pass Fail Option 3 used then: Initial leakage prior to start of work = CFM Final leakage after sealing all accessible leaks using smoke test = _ CFM 3 Initial leakage _ - Final leakage _ = Leakage reduction _ CFM ((Leakage reduction _ / Initial leakage _) x 100% _ % Reduction Pass if % Reduction >= 600/6 Pass 13 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 own - o •*11PK AqI Reg: 213-A0043435A-M2100001A-0000 Registration Date/Time: 2013/07/08 18:42:37 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 rI INSTALLATION CERTIFICATE CF-611-MECH-2I-HERS Duct Leakage Test - Existing Duct System (Page 2 of 2) Site Address: 78620 FORBES CIRCLE, La Quinta CA 92253 (System Enforcement Agency: Permit Number: 1) City of La Quinta 13-0747 s ® 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 beysealed to the -drywall if smoke test is utlllzed�4orr,, compliance - appliesrto duct leakage compliance option 3'(leakage'reducti6in by. 60%) and optior-4�(fix aWaccessible leaks) described above. - ® New duct Installations -Cannot utilize building cavities asiplenumsor.platform returns in lieu of,ducts. t '' �' _ tYr$c w`` .ice" ® Mastic and: draw, bands must;be used: in combination.with cloth backed rubb&adhesive ductlape 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 -1R that apply to the installation have been met. • I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. I will ensure that all Installation Certificates will come from a HERS provider data registry for multiple orientation alternatives, and beginning October 1, 2010, for all low-rise residential buildings. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) HARRISON ENTERPRISES INC dba GENERAL AIR CONDITIONING Responsible Person's Name: Responsible Person's Signature: Danielle Garcia Danielle Garcia CSLB License: Date Signed: 16/17/2013 Position With Company (Title): 686310 Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? p Yes ❑ No Reg: 213-A0043435A-M2100001A-0000 Registration Date/Time: 2013/07/08 18:42:37 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 6) Site Address: Enforcement Agency: Permit Humber: 78620 FORBES CIRCLE, La Quinta CA 92253 1 City of La Quint a 13-0747 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, unless the TMAH Compliance Option is chosen. 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 5/16 inch (8 mm) access hole 1 upstream of evaporative coil in the ® Yes ❑ Yes ❑ Yes ❑ Yes return plenum and labeled according ❑ No ❑ No ❑ No ❑ No to Figure.in-Section RA3.2.2.2.2.- Retufri side ofthe duct system is-. located entirely with L7 Yes D Yes ❑ Yes ❑ Yes la space and return iYlow temperature , ,❑ N -c( ❑"No ❑ No'"-,, U No to'be measured; at the return ,grille. - 5/16 inch (S_tWm):access hole, 2 downstream of evaporative: coil in the Yes ❑ Yes_ ❑ Yes' ❑-Yos supply plenum and labeled according ❑ No ❑ No ❑ No ❑ No to Figure in Section RA3.2.2.2.2. The TMAH Compliance Option should be checked only if it is physically impossible to drill the TMAH as required by Section RA3.2.2.2.2. Using this Compliance Option requires the HVAC installer to annotate on the HERS Provider's data registry an explanation as to why the TMAH cannot be installed on the system, and photographs of the equipment on which the TMAH cannot be installed. Use of this Compliance Option also requires minimum airflow verification through the direct measurement of airflow per RA3.3 For more information see http://www.energy.ca.gov/title24/2008standards/special case appliance/ TMAH Compliance Option ❑ ❑ ❑ ❑ Yes to 1 and 2, or Yes to la and 2, or checking the TMAH Compliance Option, is ® Pass ❑ Pass ❑ Pass ❑ Pass a pass. ❑ Fail ❑ Fail ❑ Fail ❑ Fail Enter Pass or Fail Reg: 213-A0043435A-M2500001A-0000 Registration Date/Time: 2013/07/08 18:44:43 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2013 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 6) Site Address: Enforcement Agency: Permit Number: 78620 FORBES CIRCLE, La Quinta CA 92253 City of La Quint a 13-0747 STMS - Sensor on the Evaporator Coil System Name or System 1 -T Identification/Tag 31by he sensor is factory installed, or field installed according to manufacturer's specifications, or is installed methods/specifications approved by the Executive Director. ❑ Yes ❑ No I ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No The sensor wire is terminated with a standard mini plug suitable for connection to a digital thermometer. 4 The sensor mini plug is accessible to the installing technician and the HERS rater without changing the airflow through the condenser coil ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No 5 IThe sensor measures the saturation temperature of the coil within 1.3 degrees F ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No Yes to 3, 4, and 5 is a e pass. Enter N/A if STMS are not ® N/A ❑ N/A ❑ N/A ❑ N/A applicable. ❑ Pass ❑ Pass ❑ Pass ❑ Pass Otherwise enter Pass or ❑ Fail ❑ Fail ❑ Fail ❑ Fail Fail STM5 - Sensof on the Condenser Coil System Name orilSystern 1, Identification/Tag 6 ITh=is factory installed,�orjfteld installed according�tojmanufacturer's specifications; -or is installed by/specifications approved by the Executive�pirector: .�' '.a ' ",. „"'',.:#---.- ._ 5° .J ; r j,❑,Yes„❑ No It. 11 Yes ,❑ o ._, F ❑Yes ❑ No❑Yes ❑.Nom The "sensor wirejs[terminatedjwith a>standard mini plug,suitable'forconnection to a digital thermometer. 7 The sensor mim plug"is•accessible,to`°the ins talling,technician an�-the MFRS rater without-chan,gmg`the airflow through the condenser coil []Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No 8 The. -sensor measures the saturation temperature of the coil within 1.3 degrees F i' ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No Yes to 6, 7, and 8isa e pass.° Enter N/A if STMS are not ❑ N/A ❑ N/A ❑ N/A ❑ N/A applicable. ❑ Pass ❑ Pass ❑ Pass ❑ Pass Otherwise enter Pass or ❑ Fail ❑ Fail ❑ Fail ❑ Fail Fail Reg: 213-A0043435A-M2500001A-0000 Registration Date/Time: 2013/07/08 18:44:43 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2013 a INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 6) Site Address: Enforcement Agency: Permit Number: 78620 FORBES CIRCLE, La Quinta CA 92253 City of La Quint. 13-0747 Standard Charge Measurement Procedure (for use if outdoor air dry-bulb temperature is 55°F or above) 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 temperature is less than 55°F, the installer must use the RA3.2.3 Alternate Charge Measurement Procedure (Weigh -In Charging Method). If the Weigh -In Method is used, the dwelling cannot be included in a sample group for HERS verification compliance.) Space Conditioninq Svstems System Name or Identification(Tag System i '(must be re -calibrated monthly) - , . System Location or Area Served Whole House 6/1/2013 (must be re -calibrated monthly) _- Outdoor Unit Serial # 1305108083 Outdoor Unit Make t GOODMAN Outdoor Unit Model'; GSX160601 Nominal Cool i ng-lCapacity 5 Tons Date ofJVerificaEion` ._ `, 6/25'j20130�' a p ri+ Calibration'tof D adn stic In truments Date of RefrigeranVGauge Calibration,. '" _f $6/1'/2013,F;'. : * "" '(must be re -calibrated monthly) - , . Supply (evaporator leaving) air dry-bulb Date of - Thermocouple Calibration 6/1/2013 (must be re -calibrated monthly) _- temperature (Tsu I db) 45 / Measured Temperatures (°F) System Name or Identification%Tag System 1 Supply (evaporator leaving) air dry-bulb 59 temperature (Tsu I db) 45 Return (evaporator entering) air 84 dry-bulb temperature (Treturn db) 105 Return (evaporator entering) air 61 wet -bulb temperature (Treturn wb) Evaporator saturation temperature 45 (Teva orator sat) Condensor saturation temperature 105 (Tcondensor, sat) Suction line temperature (Tsuction) 63 Liquid Line Temperature (Tliquid) 96 Condenser (entering) air dry-bulb 91 temperature (Tcondenser, db) 0 Reg: 213-A0043435A-M2500001A-0000 Registration Date/Time: 2013/07/08 18:44:43 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2013 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 6) Site Address: Enforcement Agency: Permit Number: 78620 FORBES CIRCLE, La Quinta CA 92253 City of La Quinta 13-0747 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 = 25.00 Treturn db - Tsupply, db Target Temperature Split from Table RA3.2-3 24 using Treturn wb and Treturn db Calculate difference: Actual Temperature 1 Split - Target Temperature Split = Passes if difference is between -3°F and +3°F or, upon remeasurement, if between PASS -3°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 measuremen"t;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. JJJ ... � �i '..•. A ..�-"'..ems �y �a� ��A..�R �� • Calculated Minimum Airflow CFM) Nominal Cooling Capac Xg3.00 F . equiremen (ton), I i SyStemNarne or3T entif xtion/Taga _ .A :' !' System 1 Y ""`��a� ` * }}`ZO Calculated Minimuin•Airflow'Requirenient .A". ' ' =.r• (CFM) Measured'Airflow using RA3.3;procedures (CFM): Measurement Method Passes if measured airflow is greater than or equal to the calculated minimum airflow requirement. f. Enter Pass or Fail .9 Reg: 213-A0043435A-M2500001A-0000 Registration Date/Time: 2013/07/08 18:44:43 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms = March 2013 INSTALLATION CERTIFICATE CF-611-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 6) Site Address: Enforcement Agency: Permit Number: 78620 FORBES CIRCLE, La Quinta CA 92253 1 City of La Quinta 13-0747 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 = 9.0 Tsuction - Teva orator sat Target Superheat from Table RA3.2-2 7 using Treturn wb and Tcondenser, db Calculate difference: 18 Actual Superheat - Target Superheat = PASSr f 0 System passes if difference is between -5°F and +5°F Enter Pass or Fail PASS 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 = 9.0 Tcondenser, sat - Tli uid Target Subcooling specified by 7 manufacturer Calculate difference: Actual`Subcooling Target 18 System passes if difference is between" -3°F anis +3°FVA' PASSr f 0 specification is not available) er�Pass or Fail { ---� ' ,�lY� i' i oll-4 k, 0 ,d n ` D'evice"Galcuiations for'Ref�'r Brant"Cta� a Veriffcationi: This " rocedui•e`is"-`re "uired'to l�e�� Meteri g 9 9. ....,.-.. P. q .. ., ., ,_ used, for thermostatic expansion valve'(TXV).and!electronicexpansion'valve (EXV) systems. ` System,Name o" r Identification/Tag System 1 Calculate: Actual Superheat Tsuction - Teva orator sat Enter allowable superheat range from manufacturer's specifications (or use range 18 between 4°F and 25°F if manufacturer's specification is not available) System passes if actual superheat is within the allowable superheat range PASS Enter Pass or Fail . Reg: 213-A0043435A-M2500001A-0000 Registration Date/Time: 2013/07/08 18:44:43 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2013 INSTALLATION CERTIFICATE CF -6R -MEC -H -25 -HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 6 of 6) Site Address: Enforcement Agency: Permit Number: 78620 FORBES CIRCLE, La Quinta CA 92253 City of La Quinta 13-0747 Standard Charge Measurement Summary: System shall pass both refrigerant charge criteria, metering device criteria (if applicable), and minimum cooling coil airflow criteria based on measurements taken concurrently during system operation. If corrective actions were taken, all applicable verification criteria must be re -measured and/or.recalculated. System Name or Identification/Tag System 1 CSLB License: 686310 Date Signed; 6/17/2013 Position With Company (Title): System meets all refrigerant charge and Name of TPQCP (if applicable): Control Program (TPQCP)? 13 Yes ❑ No airflow requirements. PASS Enter Pass or Fail ® Residential Appendix RA3.2.2 requires that if the outdoor temperature is between 55°F and 65°F the return air dry bulb temperature shall be maintained above 70°F during the Standard Charge Measurement Procedure. The signature of the Responsible Person in the declaration statement below certifies this requirement has been met for all applicable system verifications reported on this certificate. 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 samplegroup pUtnot checked by a'HEj2S ratersani if'th so e.installation3 faitomeet fheirequir mehts of such quality assurance checking, the required -corrective actronnd •a' dditronal'checking/testing of other installations in that HERS sample group will be perfo*r`med`at my expense rt,r'� • f +- =, . I reviewed a copy of the Certificate of Compliance (CF iR).form approved by the enforcement agency that identifiiTi the'. - specific requirementslor the inst6llation3I certify that the requirements detailed on !he CF -1R thot�apply to,,the have been met., �-.- . I will ensur..eitthat a completed; signed;-copy,of this I,nstailation Cert-ificate,,shall be posted,,ior made available*. with the building permit(s):issued for the building, anis made a"vailable fo tFie enforcement agencyifoeall'"'* applicable inspections. I understand that a signed copy of this Installation Certificate is required to be included with,the documentation the builder provides to the building owner at occupancy. I will ensure that all. Installation .Certificates will come from a HERS provider data registry for multiple orientation alternatives, and beginning October 1; 2010, for all low-rise residential buildings. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) HARRISON ENTERPRISES INC dba GENERAL AIR CONDITIONING Responsible Person's Name: Responsible Person's Signature: Danielle Garcia Danielle Garcia CSLB License: 686310 Date Signed; 6/17/2013 Position With Company (Title): Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? 13 Yes ❑ No Reg: 213-A0043435A-M2500001A-0000 Registration Date/Time: 2013/07/08 18:44:43 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2013 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-21 Duct Leakage Test — Existing Duct System (Page 1 of 2) Site Address: 78620 FORBES CIRCLE, La Quinta CA 92253 (System Enforcement Agency: Permit Number: 1) City of La Quinta 13-0747 Enter the Duct System Name or Identification/Tag: System 1 Enter the Duct System Location or Area Served: Whole House Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the dwelling. This installation certificate is required for compliance for alterations and additions in existing dwellings to space conditioning systems and duct systems. Note: For existing dwellings, a completely new or replacement duct system can also include existing parts of the original duct system (e.g., register boots, air handler, coil, plenums, etc.) if those parts are accessible and they can be sealed. For a completely new or replacement duct system installed in an existing dwelling, use the Installation Certificate titled 'Duct Leakage Test - Completely New or Replacement Duct System. " Duct Leakage Diaanostic Test - existinq duct system Select one compliance method from the following four choices. ❑ 1. Measured leakage less than 15% of fan flow ❑ 2. Measured leakage to outside less than 10% of Fan Flow ❑ 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 Optionsj, 2, or 3 must be attempted, beforenutilizing OptionA4 ),,, -- Determine7riorninal Fan Flow using one offthe following three calculation methods: M ✓ ❑ Cooling/ system method: Size of condenser in.Tons x.400 =. CFM' ;• "- - -. ✓ ❑Heating systern 21.7 Capacity Thousands Btu/hr CFM -- method ,x Output m of. = — _ ❑ Measuredsystem.aiMow using RA3 3 airflowtest procedures;___ CFM_ �� Option I used then:-� � 1 Allowed leakage = Fan Flow x 0.15 CFM Actual,Leakage = CFM J j 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= r_ CFM �z Pass if Leakage Actual is less than Allowed Pass a Fail Option 3 used then: Initial leakage prior to start of work = _ CFM Final leakage after sealing all accessible leaks using smoke test = _ CFM 3 Initial leakage _ - Final leakage _ = Leakage reduction CFM ((Leakage reduction _ / Initial leakage _) x 100% _ % Reduction Pass if % Reduction >= 60% Pass 0 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: 213-A0043435A-M2100001A-M21A Registration Date/Time: 2013/07/08 19:34:44 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2910 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-21 Duct Leakage Test — Existing Duct System (Page 2 of 2) Site Address: 78620 FORBES CIRCLE, La Quinta CA 92253 (System Enforcement Agency: Permit Number: 1) City of La Quinta 13-0747 i� V '.:. ❑ Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be seziled/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/a`nd. return register`'boots'�must` bo — applleeid'duct leakage compliance option 3 _ leaks) described above ❑ New duct Installations:cannot utlllze€b ullding:cavltles as plenumsoi platform returns In"lieu of ducts ; , 11ust Mastic and draw bands m6e used -in_ comb,lnation.'.wlth cloth backed. rubber adhesive duet tape to seal leaks at all new'duct connections:;,: DECLARATION STATEMENTI.. • I certify under penalty of perjury, und0the 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 -6R), signed and submitted by the person(s) responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -1R) approved by the enforcement agencv. pliance Builder or Installer information as shown on the Installation Certificate (CF -6111) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) HARRISON ENTERPRISES INC Responsible Person's Name: CSLB License: Danielle Garcia 1686310 HERS Provider Data Registry Information Sample Group # (if aPPlicable): 424667 ❑tested/verified dwelling ® not-tested/verified dwelling in la HERS sample group HERS Rater Information CaICERTS Certificate # CC1-1798765243 HERS Rater Company Name: Stratz Permit Service Responsible Rater's Name: Responsible Rater's Signature: Garrett Williams Garrett Williams Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 6/25/2013 CC2006208 Reg: 213-A0043435A-M2100001A-M21A Registration Date/Time: 2013/07/08 19:34:44 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 6) Site Address: Enforcement Agency: Permit Number: 78620 FORBES CIRCLE, La Quinta CA 92253 City of La Quinta 13-0747 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, unless the TMAH Compliance Option is chosen. STMS are only required for completely new or replacement space -conditioning systems that utilize prescriptive compliance method. TMAH - Access Holes in Supply and Return Plenums of Air Handler System Name or Identification/Tag System 1 System Location or Area Served Whole House 5/16 inch (8 mm) access hole 1 upstream of evaporative coil in the ❑ Yes ❑ Yes ❑ Yes ❑ Yes return plenum and labeled according ❑ No ❑ No ❑ No ❑ No to Figure in"-S<ection RA3.2.2.2.2. Retufn side of the duct system. is, located entirely within -conditioned ❑ Yes,y� ITYes� [3 Yes, El Yes 1a space and return.lairflow temperature (❑ No7 ❑ No r 13No",,_ No to�be measured"a't the return,grille. - - 5/16 inch_(&=mm) access hole' - 2 downstream of evaporative coil in the ❑Yes ❑Yes ❑ Yes= b Yes supply plenum and labeled"according ❑ No ❑ No ❑ No ❑ No to Figure in Section RA3.2.2.2.2. The TMAH Compliance Option should be checked only if the HERS Rater is able to confirm that it was physically impossible for,the HVAC Installer to drill the TMAH as required by Section RA3.2.2.2.2. Using this Compliance Option requires the HVAC installer to annotate on the HERS Provider's data registry an explanation as to why the TMAH cannot be installed on the system, and photographs of the equipment on which the TMAH cannot be installed. Use of this Compliance Option also requires minimum airflow verification through the direct measurement of airflow per RA3.3. For more information see http://www.eneray.ca.ciov/title24/2008standards/special case appliance/ TMAH Compliance Option ❑ ❑ ❑ ❑ Yes to 1 and 2, or Yes to la and 2, or checking the TMAH Compliance Option, is ❑ Pass ❑ Pass ❑ Pass ❑ Pass a pass. ❑ Fail ❑ Fail ❑ Fail ❑ Fail Enter Pass or Fail Reg: 213-A0043435A-M2500001A-M25A Registration Date/Time: 2013/07/08 19:36:29 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms February 2013 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 6] Site Address: Enforcement Agency: Permit Number: 78620 FORBES CIRCLE, La Quinta CA 92253 City of La Quinta 1 13-0747 STMS - Sensor on the Evaporator Coil System Name or ✓ System t , -_ - Identification/Tag 3 The sensor is factory installed, or field installed according to manufacturer's specifications, or is installed by methods/specifications approved by the Executive Director. ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No The sensor wire is terminated with a standard mini plug suitable for connection to a digital thermometer. 4 The sensor mini'plug is accessible to the installing technician and the HERS rater without changing the airflow through the condenser coil ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes []No ❑ Yes ❑ No 5 When attached to a digital thermometer, the sensor provides an indication of the saturaticn temperature of the coil. ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No Yes to 3, 4, and 5 is a pass. Enter N/A if STMS are not ❑ N/A ❑ N/A ❑ N/A ❑ N/A applicable. ❑ Pass ❑ Pass ❑ Pass ❑ Pass Otherwise enter Pass or ❑ Fail ❑ Fail ❑ Fail ❑ Fail Fail STMS - Sensor on the Condenser Coil System Name or ✓ System t , -_ - IdentificaEion/Tag a 6 The sensor is factoTiRstalled, or field installed' according to' manufacturer's specifications, or is installed by methods/specifications approved by the Executive:Director. / F, ❑ Yes ❑ Noll ❑ Yes' ❑ No ❑ Yes ❑ No ❑ Yes ❑ No r The sensoe'wire is terminated with a standard mini plug suitable for connection to"a digital thermometer. 7 The sensor mini plug is accessible to the installing technician and the HERS rater without changing the airflow through the condenser coil ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No 8 When attached to a digital thermometer, the sensor provides an indication of the saturation temperature of the coil. ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No Yes to 6, 7, and 8isa pass. Enter N/A if STMS are not ❑ N/A ❑ N/A ❑ N/A ❑ N/A applicable. ❑ Pass ❑ Pass ❑ Pass ❑ Pass Otherwise enter Pass or ❑ Fail ❑ Fail ❑ Fail ❑ Fail Fail Reg: 213-A0043435A-M2500001A-M25A Registration Date/Time: 2013/07/08 19:36:29 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms February 2013 :NSTALLATION CERTIFICATE CF-4R-MECH-2! tefrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 6 Site Address: Enforcement Agency: Permit Number: 78620 FORBES CIRCLE, La Quinta CA 92253 City of La Quinta 13-0747 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 temperature is less than 55°F, the installer must use the RA3.2.3 Alternate Charge Measurement Procedure (Weigh -In Charging Method). If the Weigh -In Method is used, the dwelling cannot be included in a sample group for HERS verification compliance.) Suace Conditioninq Svstems System Name or Identification/Tag System 1 System Location or Area Served Whole House Outdoor Unit Serial # Outdoor Unit Make Outdoor Unit Model Nominal Cooling Capacity Date of V,,&ification h Calibration ofDiagnostic Instrumen Date of Refrigerant Gauge Calibrationu''' Date of Thermocouple Calibration Measured Temperatures ('F) System Name or Identification/Tag System 1 Supply (evaporator leaving) air dry-bulb temperature (Tsu I db) Return (evaporator entering) air dry-bulb temperature (Treturn db) Return (evaporator entering) air wet -bulb temperature (Treturn wb) Evaporator saturation temperature (Teva orator sat) Condensor saturation temperature (Tcondensor, sat) Suction line temperature (Tsuction) Liquid Line Temperature (Tliquid) Condenser (entering) air dry-bulb temperature (Tcondenser, db) Reg: 213-A0043435A-M2500001A-M25A Registration Date/Time: 2013/07/08 19:36:29 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms February 2013 INSTALLATION CERTIFICATE CF-4R-MECH-2' Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 61 Site Address: Enforcement Agency: Permit Number: 78620 FORBES CIRCLE, La Quinta CA 92253 City of La Qui nta 13-0747 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 coif airflow is measured, the value must be equal to or greater than the -Calculated Minimum Airflow Requirement in the table below. Calculated Minimum Airflow eq lrement (CFM) min Noal Coolmg;Capacity (ton) X 300 (cfm/tonjif F �. System :NameoIdfica entition/Tag y Calculated Minimum'Airflow Requirement (CFM) -�-"" Measured Airflow.using RA3.3 procedures (CFM) Measurement MethodA. Passes if measured airflow is greater than or equal to the calculated minimum airflow requirement. Enter Pass or Fail ■ Reg: 213-A0043435A-M2500001A-M25A Registration Date/Time: 2013/07/08 19:36:29 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms February 2013 INSTALLATION CERTIFICATE CF-4R-MECH-2! tefrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 6' Site Address: Enforcement Agency: Permit Number: 78620 FORBES CIRCLE, La Quinta CA 92253 City of La Quinta 1 13-0747 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 systems. Al .,. System Name or Identification/Tag .:; �1. a Calculate: Actual Superheat = Enter Pass or Fail' Tsuction - Teva orator sat Tsuction - Teva orator sat Target Superheat from Table RA3.2-2 using '.-T9p; ;d, ¢ �i. yp y,,�/ Enter allowable superheat range from Treturn wb and Tcondenser, db .. i Calculate difference: between 3°F and 26°F if manufacturer's Actual Superheat - Target Superheat = specification is not available) System passes if difference is between -6°F System passes if actual superheat is within and +6°F the allowable superheat range Enter Pass or Fail Enter Pass or Fail 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 systems. Al .,. System Name or Identification/Tag .:; �1. a Calculate: Actual Subcooling =. Enter Pass or Fail' Tcondenser, sat - Tli uid ... . Tsuction - Teva orator sat Target Subcooling specified by manufacturer '.-T9p; ;d, ¢ �i. yp y,,�/ Enter allowable superheat range from Calculate diffe`r'e`nce ? Actual Subcioling :Target Subcooling', .. i System;tpasses if differ nce is between`` ` -4°F a between 3°F and 26°F if manufacturer's specification is not available) Metering Device, Calculations=for Refrigerant Charge Verification. This procedure is required to be x systems. Al .,. System Name or Identification/Tag .:; �1. a Enter Pass or Fail' Tsuction - Teva orator sat ��." n �+'�y .a{...Affii. b 3F}. F.�A•dS'..BAn d .. '.-T9p; ;d, ¢ �i. yp y,,�/ Enter allowable superheat range from manufacturer's specifications (or use range ' 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. Al .,. System Name or Identification/Tag .:; �1. a Calculate: Actual Superheat-= Tsuction - Teva orator 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 range Enter Pass or Fail Reg: 2i3-A0043435A-M2500001A-M25A Registration Date/Time: 2013/07/08 19:36:29 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms February 2013 I I it INSTALLATION CERTIFICATE CF-4111-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 6 of 6) Site Address: Enforcement Agency: Permit Number: 78620 FORBES CIRCLE, La Quinta CA 92253 City of La Qui nta 13-0747 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 68631W -' HERS Provider -Data Registry Information Group # (if applicable)#'424667 System meets all refrigerant charge and ®not-tested/verified dwellingSample lin N i .. a HERS sample group airflow requirements. HERS Rater Company Name:`'J' Stratz Permit Service Responsible Rater's Name: Responsible Rater's Signature: Enter Pass or Fail Garrett Williams Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 6/25/2013 CC2006208 0 Residential Appendix RA3.2.2 requires that if the outdoor temperature is between 55°F and 65°F the return air dry bulb temperature shall be maintained above 70°F during the Standard Charge Measurement Procedure. The signature of the Responsible Person in the declaration statement below certifies this requirement has been met for all applicable system verifications reported on this certificate. 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). 5 . 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.specifiedon 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 installationyconformtosthexrequirements-specifiedto�n the,Certificate(s)4of:Compliance (CF-1R)ra'oorove&` the enforcemesnt 46cY. "%' Builderjor Installer informationmas shown"ori,thee'Installation;Gertificate (CF -'6R) ti - Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)g , HARRISON ENTERPRISESINC _ ` :, `I 1c. "" , f°"i Responsible Person's Name �kzorf' w CSLB'Licens6 Danielle Garcia ; "� - _ ° r�;� 68631W -' HERS Provider -Data Registry Information Group # (if applicable)#'424667 tested/verified dwelling ®not-tested/verified dwellingSample lin N i .. a HERS sample group HERS Rater Information,. Ca10ERTS Certificate # CC1-1798765243 HERS Rater Company Name:`'J' Stratz Permit Service Responsible Rater's Name: Responsible Rater's Signature: Garrett Williams Garrett Williams Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 6/25/2013 CC2006208 Reg: 213-A0043435A-M2500001A-M25A Registration Date/Time: 2013/07/08 19:36:29 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms February 2013