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11-0967 (MECH)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 11-00000967 Property Address: 50325 GRAND TRAVERSE AVE APN: 770-050-028-27 -25389 - Application description: MECHANICAL Property Zoning: MEDIUM DENSITY RES Application valuation: 15000 Applicant: , Architect or Engineer: 'N `°ti �i ------------------ LICENSED CONTRACTOR'S DECLARATION BUILDING & SAFETY DEPARTMENT BUILDING PERMIT I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License Class: C20 C38 eta n No.: 266204 ,Date: Contractor: OWNER-BUILDER DEC TION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: (_) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). (_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). 1 I I am exempt under Sec. , B.&P.C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY 1 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: HEFFERNAN JOHN E & JEANNE 50325 GRAND TRAVERSE AVE LA QUINTA, CA 92253 Contractor: KENNEDY BROS REFRIGERATION 84119 INDIO BLVD INDIO, CA 92201 (760)347-5417 Lic. No.: 266204 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 ------------------ 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 AMGUARD INS Policy Number YEWC212414 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 3700 of the Labor C , I shall fo with co pt! (th those provisions. &Date:SP Applicant: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COV E 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. 1 certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and her thorize representatives of this county ,to io p%enter upon the above-mentioned propert for ins c urpo Pate: / / I / Signature (Applicant or Agent): Application Number . . . . . 11-00000967 Permit MECHANICAL Additional desc . . Permit Fee . . . . 51.00 Plan Check Fee 12.75 Issue Date . . . . Valuation 0 Expiration Date 3/05/12 Qty Unit Charge Per Extension BASE FEE 15.00 2.00 9.0000 EA MECH FURNACE <=100K 18.00 2.00 9.0000 EA MECH APPL REP/ALT/ADD 18.00 ---------------------------------------------------------------------------- Special Notes and Comments HVAC CHANGE OUT - (2) .SPLIT -SYSTEMS 16SEER/80AFUE. 2010 CALIFORNIA BUILDING CODES. September 7, 2011 - 11:26:19 AM AORTEGA ---------------------------------------------------------------------------- Other Fees . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary ----------------- Charged Paid Credited ---------- Due Permit Fee Total ---------- -: --------- ---------- 51.00 .00 .00 51.00 Plan Check Total 12.75 .00 .00 12.75 Other Fee Total 1.00 .00 .00 1.00 Grand Total 64.75 .00 .00 64.75 LQPERMIT Sintplifled PrescHLj tive Certificate of C.ottipliance: 2008 Resideniial"HVACAlterations- CF-IR-ALT=HVAC, Clithate`Zones 10 to 15 " Sir Address: 2S fin /L 6_ Enforcement Agency: Date. Permit #: Conditioned Floor EquipmentTy List Minim tun Efficienc •Z Duct insulation requirement Area Thermostat ❑ ackaged Unit L9'Fumace I�AFUES�rd 13 COP Over 40 ft of duds added or t3'�etback W(nndoor Coil ErSEERI ❑ HSPF replaced in unconditioned space Served by system not already J drCondensing Unit a2raR �� 13 Resistance sf presto[. must be ❑ R 6 (CZ 10-13) 2 .50 t� p installed) ❑ Other O R 8 (CZ 14=1SJ I Equipment Type: Choose the equipment being installed: if more than one system, use another CF -1 R -ALT -HVAC for each system. 2. Minimum Equipment E,0' deneies: 13 SEER, 78916 AFUE, 7.7HSPFfortypical residential systems. HERS VERIFICATION SUMMARY Listed below are four HVAC alteration Options. The installer decides what work is being done and picks one of the appropriate Options. Each Option lists the HERS measures that must be 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 CF4R forms (no hand filled CF-4Rs allowed) are filled out and Beginning October 1 2010,a registered copy of the CF -1R and CF -6R shall also be on site for final Inspection. -signed. 1, HVAC Changeout Required Fortes: _ • All HVAC Equipment replaced CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH- 25 -HERS CF -4R forms: MECH- 21 and fors lits sterns MECH-25 • Condenser Coil and/or CF -6R forms: MECH-2I-HERS and (for split systems) MECH- 25 -HERS • Indoor Coil and /or CF -4R forms: MECH- 21 and (for split systems) MECH-25 • Furnace For Split Systems: Duct leakage < 15 percent; RC, CCA > 300 CFM/ton(Minimum Air Flow Requirement), TMAH For Packaged Units: Duct leakage < 15 percent Exempted from duct leakage testing if: ❑ 1 Duct system was documented to have been previously sealed and confirmed through HERS verification, or ❑ 2. Duct systems with less than 40 linear feet in unconditioned space, or ❑ 3. Existing ducts stems are constructed, insulated or sealed with asbestos ❑ 2. New HV AC System Required Forms: • Cut in or Changeout with new CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS ducts: (all new ducting gid all CF -4R forms: MECH 20-, and (for split systetns)MECH-22, and MECH 25 new equipment) For Split Systems: Duct leakage < 6 percent; RC, CCA 2:350 CFM/ton, FWD, TMAH, STMS, and either HSPP or PSPP. For Packaged Units: Duct leakage <6 percent 0 3. New Ducts with Replacement Required Forms: • Includes replacing or installing all new ducting CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-25-HERS and/or outdoor condensing unit and/or indoor CF4R forms: MECH-20 and (for split systems) MECH-25 coil and/or furnace. Not all equipment changed. For Split Systems: Duct leakage < 6 percent, RC, CCA > 300 CFM/ton, TMAH For Packaged Units: Duct leakage < 6 percent O 4. New Ducting over 40 feet Required Forms: • Includes adding or replacing more than 40 CF -611 forms: MECH-04, MECH-2I-HERS CF4R forms: MECH-21 linear feet of duct in unconditioned space. For split system or packaged units: Duct leakage < 15 percent ❑ EXCEPTION: Existing ducts stems constructed, insulated or sealed with asbestos. Contractor (Documentation Author's /Responsible Designer's Declaration Statement) • 1 certiffi- that this Certificate of Compliance documentation is accurate and complete. • 1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of Compliance. r I certifi that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24, l,aru 1 and 6 of the California Code of Regulations. • `i hr deign 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 fora royal with the_Rermitapplipation. Name: V Signature: C m i // G Address C- i 10 61Z52_- / License: City/StatcR.ip: "� 2—(5y Phone: 6, - Z .L j 7 2008 Residential Compliance Forms March 2010 Bin #• Eity of La Quin IQ Building 8z Safety Division Permit # P.O. Box 1 SO4, 7&495 Calle Tampico ' La Quinta, CA 92253 - (760) 777-7012 , <<- 09101 Building Permit Application and Tracking Sheet Project Address: SD3 Zr Gr ►yTcayerce, Own«'s Name: oho. P c A. P. Number: Address: IS-- D a 5 Trd Wr Legal Description: City, ST, Zip: p 3 Contractor:e-nne ( Q� n Telephone: - :'; r Address: ' UM -TM l Blvd Project Description: City, ST, Zip: . ,o zzo C�- Telephone C :s "':s>: `'fi . `'x ' •� State Lic. # : City Lia #: ST O Y) , Arch., Engr., Designer. Address: City, ST, Zip: Telephone: State Lic. Construction Type: Occupancy: ect type i )' R Pro circle one): New Add'n Alter Demo 1 Repair Name of Contact Person:-F�a-b e r4- k ri eAm Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: Estimated Value of Project: 15-1) N Submittal Req'd Plan Sets APPLICANT: DO NOT WRITE BELOW THIS UNE Ree'd TRACIQNG PERMIT FEES Plan Check submitted item Amount Structural Cala. Reviewed, ready for Corrections Plan Check Deposit Truss Cala. Called Contact Person Plan Check Balance Title 24 Cates. Plans picked cep Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2'' Review, ready for correctiooslissue Eieetrical Subcontactor List Called Contact Person Grant Dad Plans picked up H.O.A. Approval Plana resubmitted IN HOUSE:- �'' Review, ready for corrcctionsfissuc ee Planning Approval tPlTumbiHag Called Contact Person Pub. Wks. Appr Date of permit issue a ow School Fees 1. INSTALLATION CERTIFICATE* CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 5) Site Address: Enforcement Agency: Permit Number: 50325 Grand Traverse (zone 1), La Quinta CA 92253 1 City of La Quinta 11-0967 Note: If installation of a Charge Indicator Display (CID) is utilized as an alternative to refrigerant charge verification for compliance, a MECH-24 Certificate (instead of this MECH-25 Certificate) should be used to demonstrate compliance with the refrigerant charge verification requirement. TMAH and STMS are not required for compliance, when a CID is utilized for compliance. As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional form(s) for any additional systems in the dwelling as applicable. Temperature Measurement Access Holes (TMAH) and Saturation Temperature Measurement Sensors (SIMS) Procedures for installing TMAH are specified in Reference Residential Appendix RA3.2. If refrigerant charge verification is required for compliance, TMAH are also required for compliance. STMS are only required for completely new or replacement space -conditioning systems that utilize prescriptive compliance method. TMAH - Access Holes in Supply and Return Plenums of Air Handler System Name or Identification/Tag System 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 f 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"y / , fj System 1 - '- r� + . - /I 3 ❑ Yes p No The sensor is factory installed, orrfield installed according to manufacturer's specifications, or is. 'installed by methods/specifications approved by` he Executive' Director. 4 p Yes _ TQ No The sensor wire is terminated with a standard mini plug suitable for connection to W digital thermometer. The sensor mini plug:is.accessible tothe;installing,technician k,j and the HERS rater without changing the airnow through the condenser coil 5 ❑ Yes ❑ No IThe sensor measures the saturation temperature of the coil within 1.3 degrees F Yes to 3, 4, and 5 is a pass. Enter N/A if STMS are not applicable. Otherwise enter Pass or Fail _T ✓ 9 N/A ✓ ElPass ✓ ❑ 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 1 ❑ 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 _F ,/ 0 N/A ✓ C] Pass ✓ ❑Fail applicable. Otherwise enter Pass or Fail '] Reg: 211-A0046606B-M2500001A-0000 Registration Date/Time: 2011/09/14 14:47:12 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 0 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5) Site Address: Enforcement Agency: Permit Number: 50325 Grand Traverse (zone 1), La Quinta CA 92253 1 City of La Quinta 11-0967 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 System 1 (must be re -calibrated monthly) Date of Thermocouple, Calibration 09=10-2011. System Location or Area Served Whole House Outdoor Unit Serial # W1D1956029 Outdoor Unit Make York Outdoor Unit Model YCIF42S41 Nominal Cooling Capacity Btu/hr 42000 Date of Verification f� 09-14-2011 calibration ot. Diagnostic instruments Date of Refrigerant Gauge Calibration 09-10-2011 (must be re -calibrated monthly) Date of Thermocouple, Calibration 09=10-2011. )I -%I f/' ILI (must be re -calibrated monthly) Measured Temperatures -(?F) I I I t I L ----•'I I 4.—•'r I- k \ A System Name or Ide viii ��olilt' I n/T gl System 1 T� � Supply, (evaporator leaving) air dry-bulb 60 temperature (Tsupply, db) Return (evaporator entering) air dry-bulb 81 temperature (Treturn, db) Return (evaporator entering) air wet -bulb 68 temperature (Treturn, wb) Evaporator saturation temperature 48 (Tevaporator, sat) Condensor saturation temperature 89 (Tcondensor, sat) Suction line temperature (Tsuction) 68 Liquid Line Temperature (Tliquid) 86 Condenser (entering) air dry-bulb 81 temperature (Tcondenser, db) 7.1 Reg: 211-A0046606B-M2500001A-0000 Registration Date/Time: 2011/09/14 14:47:12 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Fors August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS z Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5) Site Address: Enforcement Agency: Permit Number: 50325 Grand Traverse (zone 1), La Quinta CA 92253 1 City of La Quinta 11-0967 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 18.8 using Treturn, wb and Treturn, db Calculate difference: Actual Temperature Split - 2.2 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) ication/Ta System Name or Id ntifg tem V S s 1' y Calculated Minimum Airflow Requi ement (CFM) Measured Airflow usmg+R 3 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 !1 Reg: 211-A0046606B-M2500001A-0000 Registration Date/Time: 2011/09/14 14:47:12 KERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5) Site Address: Enforcement Agency: Permit Number: 50325 Grand Traverse (zone 1), La Quinta CA 92253 City of La Quinta 11-0967 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 = 3.0 Tcondenser, sat - Tliquid 20.0 Target Subcooling specified by manufacturer 3 Calculate difference: 0 Actual Subcooling - Target Subcooling = 3-25 System passes if difference is between -3°F and +3°F PASS Enter Pass or Fail PASS l;` 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! 20.0 Tsuction - Tevaporator, sat Enter allowable superheat range from manufactu'rer's specifications (or use range 3-25 between 4°F and 25°F if manufacturer's specification is not available) System passes,if actual superheat is, within-the'�? allowable superheat range �/ f� PASS l;` jEnter Pass or Fail y Reg: 211-A0046606B-M2500001A-0000 Registration Date/Time: 2011/09/14 14:47:12 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5) Site Address: Enforcement Agency: Permit Number: 50325 Grand Traverse (zone 1), La Quinta CA 92253 City of La Quinta 11-0967 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: 266204 Date Signed: 19/13/2011 Position With Company (Title): System meets all refrigerant charge and airflow Name of TPQCP (if applicable): Control Program (TPQCP)? ❑ Yes ❑ No requirements. PASS Enter Pass or Fail t DECLARATION STATEMENT • I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. • I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized representative of the person responsible for construction (responsible person). • I certify that the installed features, materials, components, or manufactured devices identified on this certificate (the installation) conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the enforcement agency. . I understand that a HERS rater will check the installation to verify compliance, and that that if such checking identifies defects, I am required to take corrective action at my expense. I understand that Energy Commission and HERS provider representatives will also perform quality assurance checking of installations, including those approved as part of a sample group but not checked by a HERS rater, and if those installations fail to meet the requirements of such quality assurance checking, the required corrective action and additional checking/testing of other installations in that HERS sample group will be performed at my expense. . I reviewed a copy of the Certificate of Compliance (CF -IR) 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) Kennedy Bros. Refrigeration Inc. Responsible Person's Name: Responsible Person's Signature: Robert F Kennedy Robert F Kennedy CSLB License: 266204 Date Signed: 19/13/2011 Position With Company (Title): Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? ❑ Yes ❑ No Reg: 211-A0046606B-M2500001A-0000 Registration Date/Time: 2011/09/14 14:47:12 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS Duct Leakage Test — Existing Duct System (Page 1 of 2) Site Address: 50325 Grand Traverse (zone 1), La Quinta CA 92253 Enforcement Agency: Permit Number: (System 1) City of La Quinta 11-0967 Enter the Duct System Name or Identification/Tag: System 1 Enter the Duct System Location or Area Served: Living Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the dwelling. This installation certificate is required for compliance for alterations and additions in existing dwellings to space conditioning systems and duct systems. Note: For existing dwellings, a completely new or replacement duct system can also include existing parts of the original duct system (e.g., register boots, air handler, coil, plenums, etc.) if those parts are accessible and they can be sealed. For a completely new or replacement duct system installed in an existing dwelling, use the Installation Certificate titled "Duct Leakage Test - Completely New or Replacement Duct System." Duct Leakage Diagnostic Test - existing duct system Select one compliance method from the following four choices. © 1. Measured leakage less than 15% of fan flow t ❑ 2. Measured leakage to outside less than 10% of Fan Flow i ❑ 3. Reduce leakage by,60% and conduct smoke and fix all leaks f ❑ 4. Fix all accessible leaks using smoke and HERS rater verify Note: (One of Options_ 1, 2 or 3 must be,attempted before utilizing, Option 4.)_ Determine nominal Fan Flow using one of the following three calculation methods.r ! ✓ Cooling system method:Size of condenser in Tons 3.5 x 400 = - 1400 CFM ^ 1 {r r, ✓ ❑ Heating system method: 21.7 x fff Output Capacity in Thousands of. Btu/hr = _ CFM � 'CFM ✓ ElMeasured system alirflo w -using`R 3.3'airflow estprocedures: Option 1 used then: 1 Allowed leakage = Fan Airflow 1400 x 0.15 = 210 CFM Actual Leakage = 60 CFM Pass if Actual Leakage is less than Allowed leakage Pass ❑ Fail Option 2 used then: 2 Allowed leakage = Fan Airflow _ x 0.10 = _ CFM Actual Leakage to outside = _ CFM Pass if Actual leakage to outside is less than Allowed leakage ❑ Pass El Fail Option 3 used then: Initial leakage prior to start of work = CFM Final leakage after sealing all accessible leaks using smoke test = CFM 3 Initial leakage _ - Final leakage _ = Leakage reduction CFM ((Leakage reduction _ / Initial leakage x 100% _ % Reduction Pass if % Reduction > 600/a Ei Pass Ei 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 0 Reg: 211-A0046606B-M2100001A-0000 Registration Date/Time: 2011/09/14 14:44:28 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 i� INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS Duct Leakage Test - Existing Duct System (Page 2 of 2) Site Address: 50325 Grand Traverse (zone 1), La Quinta CA 92253 Enforcement Agency: Permit Number: (System 1) City of La Quinta 11-0967 J R 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 md ust be,sealed to the drywall. if, smoke test' is utilizeor�compliance - appliesAo duct leakage compliance option 3 (leakage reduction,by 60%) and option =41(fix all -.accessible leaks) described above. o 0 New duct installations',can not utilize, building cavities as plenums or platform returns in lieu of ducts ~ nou &CO 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) Kennedy Bros. Refrigeration Inc. Responsible Person's Name: Responsible Person's Signature: Robert F Kennedy Robert F Kennedy CSLB License: 266204 Date Signed: 9/14/2011 Position With Company (Title): Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? ❑ Yes ❑ No Reg: 211-A0046606B-M2100001A-0000 Registration Date/Time: 2011/09/14 14:44:28 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 .0 l 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: 50325 Grand Traverse (zone 1), La Quinta CA 92253 1 City of La Quinta 11-0967 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 Living 1 ©Yes El N / ' 5/16 inch (8 mm) access hole upstream of evaporative coil in the return plenum and labeled according to Figure in Section RA3.2.2.2.2. 2 p Yes ❑ No 5/16 inch (8 mm) access hole downstream of evaporative coil in the supply plenum and labeled according to Figure in Section RA3.2.2.2.2. Yes to -land -2 is a pass. Enter Pass or Faill ✓ 0 Pass ✓ ❑ Fail I STMS-_Sensor.onAhe Evaporator Coil_.__._ _ _ System Name'or Identification/Tag_? J .'/r System 1' ' '° - f v, II The sensor is factory installed, or field installed according to manufacturer's The sensor is factory installed, orifield installed according to manufacturer -'s 3 (E] es p No. specifications, or is installed by methods/specification's`approv ed by the Executive Director. Director. f r t tL �. 1 `jl(� No L The sensor wire is terminated with a standard mini plug suitable for connection,to of digital.thermometer.,The plug'.is the:insEaliing,ted nicia' k—'v 4 i+ O.Yes s ❑ sensor. mini accessible to and the HERS rater without changing the airflow through the condenser coil and the HERS rater without changing the airflow through the condenser coil 5 i ❑ Yes ❑ No When attached to a digital thermometer, the sensor provides an indication of the saturation temperature of the coil. saturation temperature of the coil. Yes to 3, 4, and 5 is a pass. Enter N/A if STMS are not ✓ 2 _F 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 When attached to a digital thermometer, the sensor provides an indication of the saturation temperature of the coil. Yes to 6, 7, and 8 is a pass. Enter N/A if STMS are not ✓ D N/A ✓ El Pass ✓ ❑Fail applicable. Otherwise enter Pass or Fail Reg: 211-A0046606B-M2500001A-M25A Registration Date/Time: 2011/09/14 14:53:51 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 i 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: 50325 Grand Traverse (zone 1), La Quinta CA 92253 1 City of La Quinta 11-0967 Standard Charge Measurement Procedure (for use if outdoor air dry-bulb is above 55°F) Procedures for determining Refrigerant Charge using the Standard Charge Measurement Procedure are available in Reference Residential Appendix RA3.2. As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional forms) for any additional systems in the dwelling as applicable. • The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure. • The system must meet minimum airflow requirements as prerequisite for a valid refrigerant charge test. • If outdoor air dry-bulb is SS°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,Calibrat•on � t 09-10-201I System Location or Area Served Living Outdoor Unit Serial # WlEI022064 Outdoor Unit Make York Outdoor Unit Model YCJF42S41 Nominal Cooling Capacity Btu/hr ', i 42000 Date of Verification 09-14-2011 caliaratlon of magnostic instruments Date of Refrigerant Gauge Calibration 09-10-2011 A (must be re -calibrated monthly) � Date of Thermocouple,Calibrat•on � t 09-10-201I � t cmust be re -calibrated monthly) Measured Temperatures,('F) If I ` ! 7=!Z'1 ! �:'C 1 \ 1P System Name or Identification/.Tag t, System 1 Supply (evaporator leaving)'air dry-bulb _ 60 temperature (Tsupply, db) Return (evaporator entering) air dry-bulb 81 temperature (Treturn, db) Return (evaporator entering) air wet -bulb 68 temperature (Treturn, wb) Evaporator saturation temperature 48 (Tevaporator, sat) Condensor saturation temperature 89 (Tcondensor, sat) Suction line temperature (Tsuction) 68 Liquid Line Temperature (Tliquid) 86 Condenser (entering) air dry-bulb 81 temperature (T condenser, db) E Reg: 211-A0046606B-M2500001A-M25A Registration Date/Time: 2011/09/14 14:53:51 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-4R-MECH-2S Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of S) Site Address: Enforcement Agency: Permit Number: 50325 Grand Traverse (zone 1), La Quinta CA 92253 1 City of La Quinta 11-0967 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 18.8 using Treturn, wb and Treturn, db Calculate difference: Actual Temperature Split - 2.2 Target Temperature Split = Passes if difference is between -4°F and +4°F or, upon remeasurement, if between -4°F and PASS -100°F Enter Pass or Fail Note: Temperature Split Method Calculation is not necessary if actual Cooling Coil Airflow is verified using one of the airflow measurement procedures specified in Reference Residential Appendix RA3.3. If actual cooling coil airflow is measured, the value must be equal to or greater than the Calculated Minimum Airflow Requirement in the table below. f Calculated Minimum Airflow Requirement (CFM) = Nominal Cooling Capacity (ton) X 300 (cfm/ton) System Name o Identification/Tag Calculated Minimum Airflow Requirement (CFM) Measured'Airflow;using�RA3.3;procedures (CFM) f _._ 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 U Reg: 211-A0046606B-M2500001A-M25A Registration Date/Time: 2011/09/14 14:53:51 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-4R-MECH-2E Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5; Site Address: Enforcement Agency: Permit Number: 50325 Grand Traverse (zone 1), La Quinta CA 92253 City of La Quint a 11-0967 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 = 3.0 Tcondenser, sat - Tliquid Target Subcooling specified by manufacturer 3 Calculate difference: 0 Actual Subcooling - Target Subcooling = System passes if difference is between -4°F and +4°F PASS Enter Pass or Fail U 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.= 20.0 Tsuction - Tevaporator, sat Enter allowable superheat range from manufacturer's specifications (or use range 3-25 between 3°F and 26°F if manufacturer's specification is not available) System passesif actual superheat is'within the superheat , PASS allowable range // It U o-4 Enter Pass or Fail r � ___4 r/ , Y Reg: 211-A0046606B-M2500001A-M25A Registration Date/Time: 2011/09/14 14:53:51 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF -4R -MEC H-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5) Site Address: I Enforcement Agency: Permit Number: 50325 Grand Traverse (zone 1), La Quinta CA 92253 City of La Quinta 11-0967 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 1266204 HERS Provider Data Registry Information Sample Group # (if applicable): N/A System meets all refrigerant charge and airflow ❑ not-tested/verified dwelling in a HERS sample group requirements. PASS Energy Driven Solutions, Inc. Responsible Rater's Name: Responsible Rater's Signature: Enter Pass or Fail David Bricker Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 9/14/2011 CC2004131 G ti (70 00 DECLARATION STATEMENT, . I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. • I am the certified HERS rater who performed the verification services identified and reported on this certificate (responsible rater). • The installed feature, material, component, or manufactured device requiring HERS verification that is identified on this certificate (the installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified on the Certificate(s) of Compliance (CF -111) approved by the local enforcement agency. • The information reported on applicable sections of the Installation Certificate(s) (CF -611), signed and submitted by the person(s) responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -111) approved by the enforcement agencv. Builder or Installer information as shown on the Installation Certificate (CF -6R) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) KENNEDY BROS REFRIGERATION CO Responsible Person's Name: CSLB License: Robert F Kennedy 1266204 HERS Provider Data Registry Information Sample Group # (if applicable): N/A tested/verified dwelling ❑ not-tested/verified dwelling in a HERS sample group HERS Rater Information CalCERTS Certificate # CCI -1798590658 HERS Rater Company Name: Energy Driven Solutions, Inc. Responsible Rater's Name: Responsible Rater's Signature: David Bricker David Bricker Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 9/14/2011 CC2004131 Reg: 211-A0046606B-M2500001A-M25A Registration Date/Time: 2011/09/14 14:53:51 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-21 Duct Leakage Test — Existing Duct System (Page 1 of 2) Site Address: 50325 Grand Traverse (zone 1), La Quinta CA 92253 Enforcement Agency: Permit Number: (System 1) City of La Quinta 11-0967 Enter the Duct System Name or Identification/Tag: System 1 Enter the Duct System Location or Area Served: Sleeping 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 ❑ 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./ - V 9 Cooling system method: Size of condenser in Tons 13 5 .,x 400,L- f 1400 CFM `! 1 ! -' o ✓ - El Heating system method`. 21.7 x Output Capacity in Thousands of Btuhr — _ CFM E 04 ✓ ❑ Measured,systehi airflow;using'RA3.3 airflow test procedures: _CFM. ^` �, y Option 1 used then: 1 Allowed leakage = Fan Flow 1400 x 0.15 = 210 CFM Actual Leakage = 101 CFM Pass if Leakage Actual is less than Allowed 0 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 0 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% El Pass Fail Option 4 used then: 4 All accessible leaks repaired using smoke. HERS rater must verify (No sampling). No smoke allowed to leak from system. Including ducts, plenums, air handler and door panel. Pass if all accessible leaks have been repaired using smoke Pass Fail il Reg: 211-A0046606B-M2100001A-M21A Registration Date/Time: 2011/09/14 14:50:37 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 Ca CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-21 Duct Leakage Test — Existing Duct System (Page 2 of 2) Site Address: 50325 Grand Traverse (zone 1), La Quinta CA 92253 Enforcement Agency: Permit Number: (System 1) City of La Quinta 11-0967 © 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. ,-� ;�"'�,►7 � x"`5"7 2 All supply/and return register boots'rnust be�sealed'to the drywall if, smoke test is utilized for, compliance - applies`to duct leakage compliance option 3 (leakage reducti6mby 60%) and option 41.(fix all accessible leaks) described above: r1 F �-�°� fj1 y�q y� f © New duct installations'.cannot utilize building cavities asfplenums or platform returns In lieu of ducts. ccs R1 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 Certificate(s) of Compliance (CF -111) approved by the enforcement agency. Builder or Installer information as shown on the Installation Certificate (CF -6R) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) KENNEDY BROS REFRIGERATION CO Responsible Name: License: Robert F Kennedy 726L6204Person's HERS Provider Data Registry Information Sample Group # (if applicable): N/A © tested/verified dwelling ❑ not -tested) verified dwelling in a HERS sample group HERS Rater Information CallCERTS Certificate # CC1-1798S906S8 HERS Rater Company Name: Energy Driven Solutions, Inc. Responsible Rater's Name: Responsible Rater's Signature: David Bricker David Bricker Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 9/14/2011 CC2004131 Reg: 211-A0046606B-M2100001A-M21A Registration Date/Time: 2011/09/14 14:50:37 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-611k-MECH-2I-HERS Duct Leakage Test — Existing Duct System (Page 1 of 2) Site Address: 50325 Grand Traverse (zone 2), La Quinta CA 92253 Enforcement Agency: Permit Number: (System 1) City of La Quinta 11-0967 Enter the Duct System Name or Identification/Tag: System 2 Enter the Duct System Location or Area Served: sleeping 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.)_ , DeterminenominalFan Flow using one of the following three calculation methods.,' tt F `= ✓ 0 Cooling system method: Size of condenser in Tons 1 3' 5 x 400 1466' CFMt IN ✓ `` ElHeatting system method: 21 .7 x _Output Capa#)city in Thousands of-Btu/hr = _CFM ✓ ❑ Measured -system airflow ;usin RA3.3 airflow test rocedures: CFM, Option 1 used then: " 1 Allowed leakage = Fan Airflow 1400 x 0.15 = 210 CFM Actual Leakage = 101 CFM Pass if Actual Leakage is less than Allowed leakage pj 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 ❑ Fail Option 3 used then: Initial leakage prior to start of work = CFM Final leakage after sealing all accessible leaks using smoke test = _ CFM 3 Initial leakage _ - Final leakage _ = Leakage reduction CFM ((Leakage reduction _ / Initial leakage x 100% _ % Reduction Pass if % Reduction > 60% Pass Fail Option 4 used then: 4 All accessible leaks repaired using smoke test. HERS rater must verify (No Sampling). Pass if all accessible leaks have been repaired using smoke Pass Fail U 0 Reg: 211-A0046609A-M2100001A-0000 Registration Date/Time: 2011/09/14 15:02:07 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: 50325 Grand Traverse (zone 2), La Quinta CA 92253 Enforcement Agency: g �' Permit Number: (System 1) City of La Quinta 11-0967 0 Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off during duct leakage,testing. CFI OA ducts that utilize controlled motorized dampers, that open only when OA ventilation is required to meet ASHRAE Standard 62.2, and close when OA ventilation is not required, may be configured to the closed position during duct leakage testing. © All supply and return register boots -must be;sealed to the drywall if, smoke test is utll¢ed ford compliance — applies,to duct leakage compliance option 3 '(leakage red uctionrby 60%) and option 41.(fix all accessible leaks) described abo.� �� l • New duct installations cannot utilize building cavities as plenumS.or platform returns in lieu ofd ct 4,11co • 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 -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) Kennedy Bros. Refrigeration Inc. Responsible Person's Name: Responsible Person's Signature: Robert F Kennedy Robert F Kennedy CSLB License: Date Signed: Position With Company (Title): 266204 9/13/2011 Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? ❑ Yes ❑ No Reg: 211-A0046609A-M2100001A-0000 Registration Date/Time: 2011/09/14 15:02:07 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS Duct Leakage Test — Existing Duct System (Page 1 of 2) Site Address: 50325 Grand Traverse (zone 2), La Quints CA 92253 Enforcement Agency: Permit Number: (System 1) City of La Quints i1-0967 Enter the Duct System Name or Identification/Tag: System 2 Enter the Duct System Location or Area Served: sleeping Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the dwelling. This installation certificate is required for compliance for alterations and additions in existing dwellings to space conditioning systems and duct systems. Note: For existing dwellings, a completely new or replacement duct system can also include existing parts of the original duct system (e.g., register boots, air handler, coil, plenums, etc.) if those parts are accessible and they can be sealed. For a completely new or replacement duct system installed in an existing dwelling, use the Installation Certificate titled "Duct Leakage Test - Completely New or Replacement Duct System. " Duct Leakage Diagnostic Test - existing duct system Select one compliance method from the following four choices. 0 1. Measured leakage less than 15% of fan flow ❑ 2. Measured leakage to outside less than 10% of Fan Flow ❑ 3. Reduce leakage by 60% and conduct smoke and fix all leaks ❑ 4. Fix all accessible eaks using smoke and HERS rater verify Note: (One of Options 1, 2 or 3 must be attempted before_ utilizing, Option 4.)t Determine nominal Fan Flow using one of the following three calculation methods.' 1/ `system Y ✓ 2 Coolliing methodd:✓Siize of' condenser in Tons 13 S x 400 = 1400` CFM ✓ ❑ Heaping system method: 21.7 x _Output Capacity in Thousands of Btu/hr = _CFM ✓❑Me sured_syste}irflousg RA3.3'airFlowest"procedures: CFM ,� f� Option i used then: 1 Allowed leakage = Fan Airflow 1400 x 0.15 = 210 CFM Actual Leakage = 101 CFM Pass if Actual Leakage is less than Allowed leakage R 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 ❑ 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 Li Fail U 4) Reg: 211-A0046609A-M2100001A-0000 Registration Date/Time: 2011/09/14 15:02:07 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: 50325 Grand Traverse (zone 2), La Quinta CA 92253 Enforcement Agency: Permit Number: (System 1) City of La Quinta 11-0967 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. 21 All supplyland return register`bootsAust be sealed to the drywall if,sm6ke test is utilized for,.compliance - applies,to duct leakage compliance option 3 '(leakage reduction, by 60%) and option 4i(fix all accessible leaks) described above. f • 1 f t 0.New duct installations' cannot utilize building cavities aslplenu'ms or platform returns in lieu of ducts: 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 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) Kennedy Bros. Refrigeration Inc. Responsible Person's Name: Responsible Person's Signature: Robert F Kennedy Robert F Kennedy CSLB License: Date Signed: Position With Company (Title): 266204 9/13/2011 Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? ❑ Yes ❑ No Reg: 211-A0046609A-M2100001A-0000 Registration Date/Time: 2011/09/14 15:02:07 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE* CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 5) Site Address: Enforcement Agency: Permit Number: 50325 Grand Traverse (zone 2), La Quinta CA 92253 1 City of La Quinta 11-0967 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 2 System Location or Area Served sleeping 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 ✓ 2 Pass ✓ ❑ Fail STMS - Sensor on.the Evaporator Coil _ System Name or Identification/Tag" y rf System 2 , 3 ❑ Yes EINo' The sensor is factory installed, or}field installed according to manufacturer's specifications, or is'installed by methods/specifications approved by the Executive Director. 4 ❑ Yes_..,) '[D 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 installing,,tecKnician t ; -No and the HERS rater without changing the airflow through the condenser'coil' 5 ❑ Yes El The sensor measures the saturation temperature of the coil within 1.3 degrees F Yes to 3, 4, and 5 is a pass. Enter N/A if STMS are not applicable. Otherwise enter Pass or Fail ✓ D N/A ✓ ❑Pass ✓ E] Fail STMS - Sensor on the Condenser Coil System Name or Identification/Tag I System 2 The sensor is factory installed, or field installed according to manufacturer's 6 ❑ 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 I No IThe sensor measures the saturation temperature of the coil within 1.3 degrees F Yes to 6, 7, and 8 is a pass. Enter N/A if STMS are not V 0 N/A ✓ ❑ Pass ✓ ❑ Fail applicable. Otherwise enter Pass or Fail Reg: 211-A0046609A-M2500001A-0000 Registration Date/Time: 2011/09/14 15:08:25 HERS Provider: Ca10ERTS, 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: Enforcement Agency: Permit Number: 50325 Grand Traverse (zone 2), La Quinta CA 92253 1 City of La Quinta 11-0967 Standard Charge Measurement Procedure (for use if outdoor air dry-bulb is above SS°F) Procedures for determining Refrigerant Charge using the Standard Charge Measurement Procedure are available in Reference Residential Appendix RA3.2. As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional forms) for any additional systems in the dwelling as applicable. • The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure. • The system must meet minimum airflow requirements as prerequisite for a valid refrigerant charge test. • If outdoor air dry-bulb is 55°F or below, the installer must use the Alternate Charge Measurement Procedure. Space Conditioning Systems System Name or Identification/Tag System 2 (must be re -calibrated monthly) Date of Thermocouple,"'Calibration j� r -1i 09=10-201 �{,. System Location or Area Served sleeping J Outdoor Unit Serial # WlEI022064 ---* —�- ,V 4,-- V v Outdoor Unit Make York Outdoor Unit Model YCF342S41 Nominal Cooling Capacity Btu/hr 42000 Date of Verification f 09-14-2011 calibration of Diagnostic instruments Date of Refrigerant Gauge Calibration -,` 09-10-2011 - - (must be re -calibrated monthly) Date of Thermocouple,"'Calibration j� r -1i 09=10-201 �{,. i r. Al /.f 7r u , ;must be re -calibrated monthly) 1f J Measurea iemDeraturesa-")-) ■ i f t I I 1 \ \ h System Name or Identification/Tag r System 2 A I .L .-,f'tIArtt#Ir,l r if Supply; (evaporator leaving),air dry-bulb 6! ----� ---* —�- ,V 4,-- V v temperature (Tsupply, db) Return (evaporator entering) air dry-bulb 80 temperature (Treturn, db) Return (evaporator entering) air wet -bulb 67 temperature (Treturn, wb) Evaporator saturation temperature 47 (Tevaporator, sat) Condensor saturation temperature 94 (Tcondensor, sat) Suction line temperature (Tsuction) 68 Liquid Line Temperature (Tliquid) 89 Condenser (entering) air dry-bulb 88 temperature (Tcondenser, db) 01 Reg: 211-A0046609A-M2500001A-0000 Registration Date/Time: 2011/09/14 15:08:25 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5) Site Address: I Enforcement Agency: Permit Number: 50325 Grand Traverse (zone 2), La Quinta CA 92253 City of La Quinta 11-0967 Minimum Airflow Requirement Temperature Split Method Calculations for determining Minimum Airflow Requirement for Refrigerant Charge Verification. The temperature split method is specified in Reference Residential Appendix RA3.2. System Name or Identification/Tag System 2 Calculate: Actual Temperature Split = Treturn, 19.00 db - Tsupply, db Target Temperature Split from Table RA3.2-3 18.3 using Treturn, wb and Treturn, db Calculate difference: Actual Temperature Split - 0.7 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 fag Syste 2- 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 2 Calculate: Actual Superheat = Tsuction - Tevaporator, sat Target Superheat from Table RA3.2-2 using Treturn, wb and Tcondenser, db Calculate difference: Actual Superheat - Target Superheat = System passes if difference is between -5°F and +5°F Enter Pass or Fail E Reg: 211-A0046609A-M2500001A-0000 Registration Date/Time: 2011/09/14 15:08:25 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: Enforcement Agency: Permit Number: 50325 Grand Traverse (zone 2), La Quinta CA 92253 1 City of La Quinta 11-0967 Subcooling Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag System 2 Calculate: Actual Subcooling = 5.0 Tcondenser, sat - Tliquid Target Subcooling specified by manufacturer 3 Calculate difference: 2 Actual Subcooling - Target Subcooling = System passes if difference is between -3°F and +3°F PASS �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 System 2 Calculate: Actual Superheat = 21.0 Tsuction - Tevaporator, sat Enter allowable superheat range from manufacturer's specifications (or use range 3-25 between 4°F and 25°F if manufacturer's specification is not available) System passes, ifactual superheat is-within=the" allowable superheat range f -'�f PASS �f j + h,Enter Pass or Fail Reg: 211-A0046609A-M2500001A-0000 Registration Date/Time: 2011/09/14 15:08:25 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R=MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5) Site Address: Enforcement Agency: Permit Number: 50325 Grand Traverse (zone 2), La Quinta CA 92253 1 City of La Quinta 11-0967 Standard Charge Measurement Summary: System shall pass both refrigerant charge criteria, metering device criteria (if applicable), and minimum cooling coil airflow criteria based on measurements taken concurrently during system operation. If corrective actions were taken, all applicable verification criteria must be re -measured and/or recalculated. System Name or Identification/Tag System 2 CSLB License: 266204 Date Signed: 9/13/2011 Position With Company (Title): System meets all refrigerant charge and airflow Name of TPQCP (if applicable): Control Program (TPQCP)? ❑ Yes ❑ No requirements. PASS Enter Pass or Fail 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 -SR) 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) Kennedy Bros. Refrigeration Inc. Responsible Person's Name: Responsible Person's Signature: Robert F Kennedy Robert F Kennedy CSLB License: 266204 Date Signed: 9/13/2011 Position With Company (Title): Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? ❑ Yes ❑ No Reg: 211-A0046609A-M2500001A-0000 Registration Date/Time: 2011/09/14 15:08:25 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 w' CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-21 Duct Leakage Test — Existing Duct System (Page 1 of 2) Site Address: 50325 Grand Traverse (zone 2), La Quinta CA 92253 Enforcement Agency: Permit Number: (System 1) City of La Quinta 11-0967 Enter the Duct System Name or Identification/Tag: System 2 Enter the Duct System Location or Area Served: sleeping 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 r ❑ 2. Measured leakage to outside less than 10% of Fan Flow r ❑ 3. Reduce leakage by,60% and conduct smoke and fix all leaks 4.,Fix all accessible leaks using smoke and HERS rater verify Note: (One of:Options ,1, 2, or 3 must be attempted.,before,utilizing Option"4.), Determine.ribminal Fan Flow using one o�f:the"followin9 three calculation methods.#r ✓ R Cooling system method: Size of condenser in To 1 3.5 .,x 400 _ ` 1400 CFM / i, :r 11) t E ! � / �C % o� ✓ ❑ Heating system method: 21.7 x Capacity. in Thousands of Btu/hr = _`Output _CFM ✓ ❑ Measured, system airflow..using'RA3.3 airflow tes4rocedures: _ CFM. , `,,, .:n; �^y Option 1 used then: 1 Allowed leakage = Fan Flow 1400 x 0.15 = 210 CFM Actual Leakage = 101 CFM Pass if Leakage Actual is less than Allowed 0 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% _ % Reduction Pass if % Reduction > 60% Pass Fail Option 4 used then: 4 All accessible leaks repaired using smoke. HERS rater must verify (No sampling). No smoke allowed to leak from system. Including ducts, plenums, air handler and door panel. Pass if all accessible leaks have been repaired using smoke Pass Fail R Reg: 211-A0046609A-M2100001A-M21A Registration Date/Time: 2011/09/14 15:11:28 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-21 Duct Leakage Test — Existing Duct System (Page 2 of 2) Site Address: 50325 Grand Traverse (zone 2), La Quinta CA 92253 Enforcement Agency: Permit Number: (System 1) City of La Quinta 11-0967 i 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. Il All supply/end 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 60%) and option 41(fix all accessible leaks) described above f�L f © New duct installations,,cannot ute building cavities asiplenums or platform returns in lieu of ducts./ S5 L-c�fuo 21 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 -SR) approved by the local enforcement agency. • The information reported on applicable sections of the Installation Certificate(s) (CF -611), signed and submitted by the person(s) responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -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) KENNEDY BROS REFRIGERATION CO Responsible Person's Name: CSLB License: Robert F Kennedy 266204 HERS Provider Data Registry Information Sample Group # (if applicable): N/A Q tested/verified dwelling ❑ not-tested/verified dwelling in la HERS sample group HERS Rater Information Ca10ERTS Certificate # CC1-1798590659 HERS Rater Company Name: Energy Driven Solutions, Inc. Responsible Rater's Name: Responsible Rater's Signature: David Bricker David Bricker Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 9/14/2011 CC2004131 Reg: 211-A0046609A-M2100001A-M21A Registration Date/Time: 2011/09/14 15:11:28 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms 1 March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 5) Site Address: Enforcement Agency: Permit Number: 50325 Grand Traverse (zone 2), La Quinta CA 92253 1 City of La Quint a 11-0967 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 2 System Location or Area Served sleeping 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 l.and_2 is a pass. Enter Pass or Faill ✓. 0 Pass ✓ ❑Fail STMS - Sensor.on,the Evaaorator Coil -_ _....rem _ - �• System Nanie'er Identification/Tag ,I'`l- System 2 "1 j '» 1 �.Ar/ f if (j ]/ No The sensor is factory installed, or field installed according to manufacturer's methods/specifications 3 ❑ Yes p specifications, or is'installed by approved by the Executive j( 1 Director. j Y Ji r i 1 x1 it ► �► 4 JJ D.Yes 1 J .�' i] No' The sensor wire is terminated with a standard mini plug suitable for_connection,to a digital, thermometer. The'sensor mini plug - is accessible to theJnsialling technician t,} ❑ 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 El Yes El 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 V 0 N/A ✓ ❑ Pass ✓ ❑ Fail applicable. Otherwise enter Pass or Fail ✓ ❑ Pass ✓ ❑ Fail applicable. Otherwise enter Pass or Fail STMS - Sensor on the Condenser Coil System Name or Identification/Tag I System 2 The sensor is factory installed, or field installed according to manufacturer's 6 ❑ 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 El Yes El 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 0 N/A ✓ ❑ Pass ✓ ❑ Fail applicable. Otherwise enter Pass or Fail s 9 Reg: 211-A0046609A-M2500001A-M25A Registration Date/Time: 2011/09/14 15:15:23 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-2' Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5) Site Address: Enforcement Agency: Permit Number: 50325 Grand Traverse (zone 2), La Quinta CA 92253 1 City of La Quinta 11-0967 Standard Charge Measurement Procedure (for use if outdoor air dry-bulb is above 55°F) Procedures for determining Refrigerant Charge using the Standard Charge Measurement Procedure are available in Reference Residential Appendix RA3.2. As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional forms) for any additional systems in the dwelling as applicable. • The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure. • The system must meet minimum airflow requirements as prerequisite for a valid refrigerant charge test. • If outdoor air dry-bulb is 55°F or below, the installer must use the Alternate Charge Measurement Procedure. Space Conditionina Svstems System Name or Identification/Tag System 2 (must be re -calibrated monthly) Date of Thermocouple; Calibration f!( Y 09-10-2011 System Location or Area Served sleeping r a Outdoor Unit Serial # W1E1022064 Outdoor Unit Make York Outdoor Unit Model YC)F42S41 Nominal Cooling Capacity Btu/hr { 1 42000 Date of Verification 09-14-2011 Lanoration or uiaanosric instruments Date of Refrigerant Gauge Calibration 09-10-2011 (must be re -calibrated monthly) Date of Thermocouple; Calibration f!( Y 09-10-2011 (must be re -calibrated monthly) measurea temperatures I -F) f I i I I ► f ill—C ) o System Name or Identification/Tag System 2 J y) ff r a Supply (evaporator leaving)'air dry-bulb 61 temperature (Tsupply, db) Return (evaporator entering) air dry-bulb 80 temperature (Treturn, db) Return (evaporator entering) air wet -bulb 67 temperature (Treturn, wb) Evaporator saturation temperature 47 (Tevaporator, sat) Condensor saturation temperature 94 (Tcondensor, sat) Suction line temperature (Tsuction) 68 Liquid Line Temperature (Tliquid) 89 Condenser (entering) air dry-bulb 88 temperature (Tcondenser, db) x 0 E Reg: 211-A0046609A-M2500001A-M25A Registration Date/Time: 2011/09/14 15:15:23 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5) Site Address: Enforcement Agency: Permit Number: 50325 Grand Traverse (zone 2), La Quinta CA 92253 1 City of La Quinta 11-0967 Minimum Airflow Requirement Temperature Split Method Calculations for determining Minimum Airflow Requirement for Refrigerant Charge Verification. The temperature split method is specified in Reference Residential Appendix RA3.2. System Name or Identification/Tag System 2 Calculate: Actual Temperature Split = Treturn, 19.00 db - Tsupply, db Target Temperature Split from Table RA3.2-3 18.3 using Treturn, wb and Treturn, db Calculate difference: Actual Temperature Split - 0.7 Target Temperature Split = Passes if difference is between -4°F and +4°F or, upon remeasurement, if between -4°F and PASS -100°F Enter Pass or Fail Note: Temperature Split Method Calculation is not necessary if actual Cooling Coil Airflow is verified using one of the airflow measurement procedures specified in Reference Residential Appendix RA3.3. If actual cooling coil airflow is measured, the value must be equal to or greater than the Calculated Minimum Airflow Requirement in the table below. Calculated Minimum Airflow Requirement (CFM) = Nominal Cooling Capacity (ton) X 300 (cfm/ton) System Name or Identification/Tag� 1 Calculated Minimum Airflow Requirement (CFM) . I �! / l I I 1 l� a _101A -All A Measured 'Airflow:using,RA3 1procedures.ium) 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 t 0 Reg: 211-A0046609A-M2500001A-M25A Registration Date/Time: 2011/09/14 15:15:23 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5) Site Address: Enforcement Agency: Permit Number: 50325 Grand Traverse (zone 2), La Quinta CA 92253 City of La Quinta 11-0967 Subcooling Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag System 2 Calculate: Actual Subcooling = 5.0 Tcondenser, sat - Tliquid Target Subcooling specified by manufacturer 3 Calculate difference: 2 Actual Subcooling - Target Subcooling = System passes if difference is between -4°F and +4°F PASS y Enter Pass or Fail / 1---.4 Metering Device Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag System 2 Calculate: Actual Superheat = 21.0 Tsuction - Tevaporator, sat Enter allowable superheat range from manufacturer's specifications (or use range 3-25 between 3°F and 26°F if manufacturer's specification is not available) System passes1f actual superheat is within the allowable superheat rangef I/ // PASS y Pass Fail / 1---.4 -Enter or Reg: 211-A0046609A-M2500001A-M25A Registration Date/Time: 2011/09/14 15:15:23 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5) Site Address: I Enforcement Agency: Permit Number: 50325 Grand Traverse (zone 2), La Quinta CA 92253 City of La Quinta [11-0967 Standard Charge Measurement Summary: System shall pass both refrigerant charge criteria, metering device criteria (if applicable), and minimum cooling coil airflow criteria based on measurements taken concurrently during system operation. If corrective actions were taken, all applicable verification criteria must be re -measured and/or recalculated. System Name or Identification/Tag System 2 726L6204 HERS Provider Data Registry Information Sample Group # (if applicable): N/A System meets all refrigerant charge and airflow ❑ not-tested/verified dwelling in la HERS sample group requirements. PASS Energy Driven Solutions, Inc. Responsible Rater's Name: Responsible Rater's Signature: Enter Pass or Fail David Bricker Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 9/14/2011 CC2004131 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 -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 -6R) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) KENNEDY BROS REFRIGERATION CO Responsible Person's Name: License: Robert F Kennedy 726L6204 HERS Provider Data Registry Information Sample Group # (if applicable): N/A 0 tested/verified dwelling ❑ not-tested/verified dwelling in la HERS sample group HERS Rater Information CaICERTS Certificate # CCi-1798590659 HERS Rater Company Name: Energy Driven Solutions, Inc. Responsible Rater's Name: Responsible Rater's Signature: David Bricker David Bricker Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 9/14/2011 CC2004131 Reg: 211-A0046609A-M2500001A-M25A Registration Date/Time: 2011/09/14 15:15:23 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010