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11-1157 (MECH)• 4 `P.O. BOX 1504 ^' VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 10/21/11 Application Number: (11-00001157 Owner: Property Address: 50740 GRAND TRAVERSE AVE FINE BLODGETT LISA �! APN: 770-320-057-57 -25389 - 50740 GRAND TRAVERSE 1 Application description: MECHANICAL LA QUINTA, CA 92253 Property Zoning: MEDIUM DENSITY RES ( Application valuation: 13237r') Contractor: Applicant: Architect or Engineer: GENERAL AIR CONDITIONING �rOF 5.,A..1� 31170 RESERVE DRIVE l it THOUSAND PALMS, CA 92276 (760)343-7488 Lic. No.: 686310 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and P fessionals Code, and my License is in full force and effect. =Date.- Class: C20 License No.: 686310 C LDate.- Z —Contractor: WNER-BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also.requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (55001: (_) 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 ISec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). (_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). 1 _ 1 1 am exempt under Sec. , B.&P.C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued ISec. 3097, Civ. C.). Lender's Name: _ Lender's Address: t,.QPRRMIT 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 EVEREST NATL Policy Number 7600006147101 _ 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 becgMe subject to the workers' compensation laws of California, and agree that, if I should become ject to the workers' compensation provisions of Section 3700, of the Labor Code, I shall f with comply with those provisions. Date: �0 2 (Applicant: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. 1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application, the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above i mation is correct. I agree to comply with all city and county ordinances and state laws relating to building con ction, and hereby authorize representatives of this county to enter upon the above-mentioned property for in • tion purposes. Date: t0 Signature (Applicant or Agent): Application Number . . . . . 11-00001157 Permit MECHANICAL Additional desc . Permit Fee . . . . 40.50 Plan Check Fee 10.13 Issue Date . . . Valuation . . . 0 Expiration Date 4/18/12 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 9.0000 EA MECH FURNACE <=100K 9.00 1.00 16.5000 EA MECH B/C >3-15HP/>100K-500KBTU 16.50 ----------------------------------------------------=------------------------ .Special Notes and Comments .. 5 TON HVAC CONDENSER, COIL, AND FUNACE CHANGE OUT GROUND UNIT 2010 CODES. ---------------------------------------------------------------------------- Other Fees . . ... . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged Paid Credited ----------------- Due ---------------------------------------- Permit Fee Total 40.50• .00 .00 40.50 Plan Check Total 10.13 .00 .00 10.13 Other Fee Total 1.00 .00 .00 1.00 Grand Total 51.63 .00 .00 51.63 -' LQPEKNUT Sim• lifted Prescriptive Certificate of Com liance: 2008 Residential HVACAlterations CF -IR -ALT -HVAC Climate Zones 10 to .15 ' Site Address: Enforcement ency: Date: Pernrit H: Conditioned Floor Equipment T et List Minimum Efficienc Z Duct insulation requirement Area Thermostat Packaged Unit O AFUEBo% O COP Over 40 ft of ducts added or �{{�Setback ttrriace ndoor Coil ❑SEER t 3 O HSPF replaced in unconditioned space Served by system (lfnot already rdensing Unit O EER J l ❑Resistance ❑ R 6 (CZ 10-13) ❑ R 8 (CZ 14-15) sf present, must be installed) O Other 1. Equipment Type: Choose the equipment being installed; ijmore than one system, use another CF -1 R -ALT -HVAC jor each system. 2. Minimum Equipment Efficiencies: 13 SEER, 73%AFUE, 7.7HSPFfor 0pical residential syslems. HERS VERIFICATION SUMMARY Listed below are four HVAC alteration Options. The installer decides what work is being done and .picks one of the appropriate Options. Each Option lists the HERS measures that must be conducted. A copy of the forms shall be left on site for final .inspection and a copy given to the homeowner. At final, the inspector verifies that the work listed on this form was in fact the work completed by the installer. The inspector also verifies that each appropriate CF -611 and registered CF -4R forms (no hand filled CF-4Rs allowed) are filled out and si ed. Beginning October I, 20 1.0, a registered copy of the CF -IR and CF -6R shall also be on site for final inspection. 1. HVAC Changeout Required Forms: -: All HVAC Equipment replaced CEbR forms: MECH-04,.MECH-2-I-HERS and (for -split systems) MECH- 25 -HERS - CF -4R forms: MECH- 21 and fors lits stems) MECH-25 • Condenser Coil and /or CF-611forms: MECH-2I-HERS and (for split systems) MECH- 25 -HERS • Indoor Coil arid /or CF -4R forms: MECH- 21 and (for split systems) MEC14-2.5 • Furnace For Split Systems: Duct leakage < 15 percent; RC, CCA > 300 CFM/ton(Minimum Air Flow Requirement), TMAH For Packa ed Units: Duct leakage < 15 percent . Exempted om duct leakage testing if: I. Duct system was documented to have been previously sealed and confirmed through HERS verification, or O 2. Duct systems with less than 40 linear feet in unconditioned space, or O 3. Existing duct systems are constructed, insulated or sealed with asbestos ❑ 2. New HVAC System Required Forms: • Cut in or Changeout with new CF -611 forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS ducts: (all new ducting and all CF -4R forms: MECH 20-, and (for split systems)MECH-22, and MECH 25 new equipment) For Split Systems: Duct leakage < 6 percent; RC, CCA > 350 CFM/ton, FWD, TMAH, SIMS, and either HSPP or PSPP. For Packaged Units: Duct leakage < 6 percent ❑ 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 CF -4R forms: MECH-20 and (for split systems) MECH-25 coil and/or furnace. Not all equipment changed. For Split Systems: Duct leakage < 6 percent, RC, CCA > 300 CFM/ton, TMAH For Packaged Units: Duct leakage <.6 percent ❑ 4. New Ducting over 40 feet ItRequired Forms: • Includes adding or replacing more than 40 -6R forms: MECH-04, MECH-2I-HERS CF -4R forms: MECH-21 linear feet of duct in unconditioned space. For split system or packaged units: Duct leakage < 15 percent O EXCEPTION: Existing ducts stems constructed, insulated or sealed with asbestos. Contractor (Documentation Author's /Responsible Designer's Declaration Statement) • I certify that this Certificate of Compliance documentation is accurate and complete. • I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of Compliance. • 1 certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24, Parts I and 6 of the California Code of Regulations. • The design features identified on this Certificate of Compliance are consistent with the ' arm tion documented on other pylic ompliance forms, worksheets, calculations, plans ands specifications submitted to the enforcement agency fora ro al with t e permit application.' Name: Chen wQ-*cSBil Si lure: Company: �Date: G�eti era.( 41r Cort A; {-� ort r 116--a0--iq Address: 31)70 ,�•eserUZ t �� /�5� License: &8(13/0 City/State/Zip: �—�D � �a� s, Gr} q��7� Phone: 760-31V3_74ee? Ca10ERTS - CF -1R Registration Page IotI Public Home Slicure Home About Us Training Rater Directory Forms Membership Benefits Events Industry Partners News To register for our monthly newsletter, please click here. Danielle Garcia logged in [Logout] [Home] CONGRATULATIONS Your CF -IR -ALT -HVAC Registration is complete! You may want to print this page for your records. Site Address: 150740 GRAND TRAVERSE AVE La Quinta, CA 92253 CEC Registration: 1211-A0054757A-00000000-01300 CF -IR -ALT -HVAC: CLICK HERE TO DOWNLOAD Assigned Company: HARRISON ENTERPRISES INC Do you know your HERS Rater? If you do, you may want to send this CF -1R to them. Ca10ERTS Rater ID: OR' My Rater Quick Select: Energy Driven Solutions, Inc. Every CaICERTS rater has a license number. !f you need to find the rater by name [Click HERE] to search our directory. j SEND,CF:�11R.-TQ,HER5 RATER I [CLICK HERE] to do another C'opyrighi 0 2010 C:alCER:fS, Inc. All rights reserved. Revised: .lanuary H. 2010 [Terms and Conditions] [Privacy Statement] [Class Cancellation Policy] Ca10ERTS, Inc., 31 Natoma St Suite 120, Folsom,, CA 95630 Office: 916-985-3400,Toll Free: 877-HERS-R8R, (877-437-7787) Fax: 916-985-3402 Contact Us .y T BBB findusonFaCtebook© �. :.... https://www.calcerts.com/public—cflk.cfm?project—id=145016 10/20/2011 Bin # 'Permit # Project Address CSO A. P. Number: City of La QUInt'd Building w Safetypivision P.O. Box 1504, 78-495 Calle Tampico 1.a Quinta, CA 92253 - (760) 777-7012 Building Permit Application and. Tracking Sheet ' /� p,� �! �(�QiUpit wner's Name: [��GC� ' 1O �� /moo Address:QZd Legal Description: City, ST, Zip: Contractor: Address: 42__ Project Description: City, ST, Zip: IVA X J Telephone: State Lic. # : Arch., Engr., Designer: 3 I : 3V City Lie. Address: -City., ST, Zip:- Telephone:' P7 State Lic. #:,.,€ Name of Contact •Person: � J.••f. jT� ....:: • •;�s J .{� j walliy'r•'%°.(: Construction Type: Occupancy: .,,�>; ,�,. fj:�r ;,;�� ,; ,• •• ,,,.. ; Project type (circle one): New Add'n Alter Repair 'Demo CO (,(e e4 (amu; c rYU Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: %< % �$ Estimated Value of Project: I3 a—i� 7 APPLICANT: DO. NOT WRITE. BELOW THIS LINE # Submittal Plan Sets Req'd Rec'•d TRACKING Plan Check submitted PERMIT FEES Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calls. Called Contact Person Plan Check Balance. Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2"" Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up. S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- ''d Review,.ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person Pub. Wks. Appr Date of permit issue School. Fees . Total Permit Fees 0 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4111-MECH-21 Duct Leakage Test — Existing Duct System (Page 1 of 2) Site Address: 50740 GRAND TRAVERSE AVE, La Quinta CA 92253 Enforcement nt Agency: Permit it Number: umber: (System 1) City Laement 11-1ency: Enter the Duct System Name or Identification/Tag: Enter the Duct System Location or Area Served: Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the 1 welling. 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 ;-nclude existing parts of Fhe 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, ise the Installation Certificate titled "Duct Leakage Test - Completely New or Replacement Duct System." Duct Leakaqe Diaqnostic Test - existinq duct system Select one compliance method from the following four choices. ❑ 1. Measured leakage less than 15% of fan flow ❑-2.Measured-Ilea kage•'to-outsideiess'-this-r•4_%_-a€-FaR.IF'ow-__._. ...._. -_-___ n 3. Reduce leakage by 60% and conduct smoke and fix all leaks ❑ 4.•.Fix all accessible leaks using.sm�ioke and HERS rater verify Note: (One of Options 1, 2, or 3 mustrbe.attempted. b,efor�,utiliziing Ogtion Determinenominal`FanFlow using onejoft�hefollowingfh°ree calculetionrnethotls� �7 , ✓ ❑ Cooling system method: Size of condenser in Tonsxf400 CFM ✓ g ❑ Hea ystem method Y . 7 Output -iiWin Thousands of Btu/hr r ✓ ❑ Measured�systeMW#a flow using RA3 3 ai grtlow test pro edurxies CFM u Option=V6sedthen 10-94, P. 4 4 s� acs 1 Allowed leakage - Fan Flow ' x 0 S5 _ CFM Actual L,eakagd = _ CFM ; Pass if Leakage Actual is less than Allowed El Pass Fail Option 2 used then':';., Ex 2 Allowed leakage = Fail -'.--Flow 0.10 = _ CFM Actual Leakage to outside-.= CFM '= Pass if Leakage Actual is less than Allowed Pass D Fail Option 3 used then: Initial leakage prior to start of work = _ CFM 4 ' Final leakage after sealing all accessible leaks using smoke test = CFM 3 Initial leakage _ - Final leakage _ = Leakage reduction_CFM ((Leakage reduction _ / Initial leakage _) x 100% _ Reduction Pass if % Reduction > 60% 0 Pass Fail Option 4 used then: 4 All accessible leaks repaired using smoke. HERS rater•must verify (No sampling). No smoke allowed to leak from system. Including ducts; plenums, air handler and door panel. Pass if all accessible leaks have been repaired using smoke El Pass Fail �1 Reg: 211-A0054757A-M2100001A-M21A Registration Date/Time: 2011/12/05 21:45:26 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 0 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-21 Duct Leakage. Test _ Existing Duct System (Page 2 of 2) Site Address: 50740 GRAND TRAVERSE AVE, La Quinta CA 92253 Enforcement Agency: Permit Number: (System 1) City of La Quinta 11-1157 ❑ Outside air (OA) ducts for Cental Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off during •duct leakage testing. GENOA 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 posit on during duct leakage testing ❑All supply l, nd r ,rn register oois must tiI sealed to the drywall if smoke te�stsis u�tlli edif)¢ compliance - applie)toduct leakage compl anceop.tion 3 (leakage reduction by: 60%);:andoption 4(.fix all -accessible ',. ..­ leaks) descnbed above f __ ❑ New duc%nstallations cannot utilizeE buildimg caulties as$plenums or platform returns in lieu of ducts r ? k.. r It ..V( •,, or T ;` `,� � �' t - 'Y+-' �' R, "zip; „ ., �;�,: ❑ Mastic andWaw ban`ds'rnust�be usedvIin�combination:with cloth<6acked.�ubber adhesi :9duct t pie to seal '.....F leaks at all new duct connections' DECLARATION STATEMENT . I certify under penalty of perju„ry, under the laws of the State of California, the information provided on this form is true and correct. . I am the certified HERS rater wfio. 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 persons) responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -11R)' approved by the enforcement agency. Builder or Installer information as shown on the Installation Certificate (CF -6111) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) HARRISON ENTERPRISES INC Responsible Person's Name: CSLB License: Danielle Garcia 1686310 HERS Provider Data Registry Information Sample Group # (if applicable): 267786 ❑ tested/verified dwelling not-tested/verified dwelling in la HERS sample group HERS Rater Information CaICERTS.Certificate # CCl-1798601445 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: 12/1/2011 . CC2004131 Reg: 211-A0054757A-M2100001A-M21A Registration Date/Time: 2011/12/05 21:45:26 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 1 of 5; Site Address: Enforcement Agency: Permit Number: 50740 GRAND TRAVERSE AVE, La Quinta CA 92253 [CityofLaQuinta 11-1157 Note: If installation of a Charge Indicator Display (CID) is utilized as an alternative to refrigerant charge verification for compliance, a MECH-24 Certificate (instead of this MECH-25 Certificate) should be used to demonstrate compliance with the refrigerant charge verification requirement. TMAH and STMS are not required for compliance; when a CID is utilized for compliance. As many as 4 systems in the dwelling can be documented for compliance using this -form. Attach an additional form(s) for any additional systems in the dwelling as applicable. Temperature Measurement Access Holes (TMAH) and Saturation Temperature Measurement Sensors (STMS) Procedures for installing TMAH are specified in Reference Residential Appendix RA3.2. If refrigerant charge verification is required for compliance, TMAH are also required for compliance. STMS are only required for completely new or replacement space -conditioning systems that utilize prescriptive compliance method. TMAH - Access Holes in Supply and Return Plenums of Air Handler System Name or Identification/Tag System Location or Area Served 1 ❑ Yes ❑ No _. 5/16 inch (8 mm) access hole' upstream of evaporative coil in the return plenum and labeled according to Figure_ in Section RA3.2,2,2._2., 1-'2-. ❑Yes W ❑ No ? inch'(8-rnni j'acces's'hoie downstream' of evaporati'v'e coil in fhe supply 'plenum and labeled according to Figure in Section RA3.2.2.2.2. Yes to land 2 is a pass.; Enter Pass or Faill ✓ ❑ Pass I ✓ ❑ Fail STMS`= Sensor.onmthe Evaporator Coil. System Name'or;Ide6tiftption/Tag' WN 3O`. 3 ®Yes ®"No Thesen'sor is facto installed; `orfieldis talled'accordmg to"manufacturer s . specifications, or is ins[alled by methods/s`pecfications approved byithe Executive ❑ Yes ❑ No specifications, or is installed by methods/specifications approved by the Executive Director. 4 p Yes IO >f No Thesensorwi"r„els terminat tlwEth astandardmnplug suitable forconne*ctionftoaa digital -thermometer The sensor�mni plug israccessiDie`to the installing technician `� ❑ Yes ❑ No «” :and n coniienser coil thheHERSater�withoukchagin"grthe ai'.rflow..th'rough theh(jh 5 ,. [:1Ye�f'+ ❑ No attached tal meter, the sensor provides an indication of the aturation ❑ Yes ❑ No When attached to a digital thermometer, the sensor provides an indication of the tempe� tureiof the coil pass. Enter N/A if STMS are not Yes to 3 *4 and 5'is a"_T N/A ❑❑Pass, ✓ ✓ El Fail applicable. Otherwise enter Pass ok1f it ✓ ✓ ❑ Fail applicable. Otherwise enter Pass or Fail STMS - Sensor on the Condenser Coil System Name or Identification/Tag The sensor is factory installed, or field installed according to manufacturer's 6 ❑ Yes ❑ No specifications, or is installed by methods/specifications approved by the Executive Director. The sensor wire is terminated with a standard mini plug suitable for connection to a 7 ❑ Yes ❑ No digital thermometer. The sensor mini plug is accessible to the installing technician and the HERS rater without changing the airflow through the condenser coil 8 ❑ Yes ❑ No When attached to a digital thermometer, the sensor provides an indication of the saturation temperature of the coil. Yes to 6, 7, and 8 is a pass. Enter N/A if STMS are not 'El ✓ 2 N/A ✓ ✓ ❑ Fail applicable. Otherwise enter Pass or Fail Reg: 211-A0054757A-M2500001A-M25A Registration Date/Time: 2011/12/05 21:47:04 HERS Provider:.CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 CERTIFICATE OF FIELD VERIFICATION& DIAGNOSTIC TESTING CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5) Site Address: Enforcement Agency: Permit Number: 50740 GRAND TRAVERSE AVE, La Quinta CA 92253 City of La Quinta 11-1157 Standard Charge Measurement Procedure (for use if outdoor air dry-bulb is above 55'1F) 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 conaitioning systems System Name or Identification/Tag System Location or Area Served Outdoor Unit Serial # Outdoor Unit Make Outdoor Unit Model Nominal Cooling Capacity Btu/hr Date of Verification;' Calibration of Diagnostic Instruments Date of Refrigerant Gauge CalibratioW?" (must be re -calibrated monthly) ¢' Date of ThermocoupleJECalibration py ' " ��� X", s_t be recalibrated month) ( y) 17 P rieasureo iemaerawres t :,r) t &�, lei a3 M . ft"'Vhv? a, ;. XaPtft 474r System Name or Identification/Tag � a,�.AN SuPPIY (evaporator leavm9) airadry b6 gum." P � * .? : •ter: . temperature (T )� supPlY, db �< Return (ev�aporatoF;(Fntering) air drybulb temperatu`.:(Tretun ddb) " `r re Return (evaporator entering_) air wet -.bulb temperature (Treturn, wb) Evaporator saturation temperature:1" (Tevaporator, sat) Condensor saturation temperature , (Tcondensor, sat) Suction line temperature (Tsuction) Liquid Line Temperature (Tliquid) Condenser (entering) air dry-bulb temperature (Tcondenser, db) Reg: 211-A0054757A-M2500001A-M25A Registration Date/Time: 2011/12/05 21:47:04 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-411-MECH-25 Refrigerant Charge Verification- Standard Measurement Procedure (Page 3 of 5) Site Address: Enforcement Agency: Permit Number: 50740 GRAND TRAVERSE AVE, La Quinta CA 92253 City of La Quinta [11-1157 Minimum Airflow Requirement Temperature Split Method Calculations for determining Minimum Airflow Requirement for Refrigerant Charge Verification. The temperature split method is specified in Reference Residential Appendix RA3.2. System Name or Identification/Tag Calculate: Actual Temperature Split = Treturn, db - Tsupply, db Target Temperature Split from Table RA3.2-3 using Treturn, wb and Treturn, db Calculate difference: Actual Temperature Split Target Temperature Split = Passes if difference is between -40E -and +4°F or, upon remeasurement, if between -4°F and -100°F Enter Pass or Fail Note:. Temperature' Split Method Calculation is not necessary if actual Cooling Coil Airflow is verified using one of the R%rf o :measurem-2nt-:procedures-specifies+•%^. Reference Residential Appens1ix RA3.3. If actual cooling coil airflow!s measured, the`velue must (ie—equal 0 & greaterThhh the Calculated_ Minim"u(ri Airflow RequirEinen� m[ne table below`. Calculated�Miriimum Airflow Requirement (CFM) = Nominal Cooling Capacity (ton) X 300 (cfm/ton) System Name,or Mentification/Tag� - ' �y.a�. ..Q#y vi: � Y.! - §S'.�1�p ,fl. R ' •' _ .�.�,.9`�., _. "�T• J `v�. : ix 3"n .� ., r.140 aid. `iriC1Sli a Calculate'd!Ainin num Airfl Requirerne (CFM) putt ..: S 5 : �'�*'�"�Y��` MeasuredAirflow using, RA3 3f procedures (CFM)SOT ... 11 Passes if measured airflow 9 is reaEetvthan ore qual ..,.;�''.t..,., to the calculated minimum airflow requirement µ Enfe�; Pass or Fail Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for fixed orifice metering deice 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 r Target Superheat = System passes if difference is between --6°F and +6°F Enter Pass or Fail Reg: 21.1-A0054757A-M2500001A-M25A Registration Date/Time: 2011/12/05 21:47:04 HERS provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-4111-MECH-25 Refrigerant Charge Verification —Standard Measurement Procedure (Page 4 of 5) Site Address: Enforcement Agency: Permit Number: 50740 GRAND TRAVERSE AVE, La Quinta CA 92253. 1 City of La Quinta • 11-1157 Subcooling Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to.be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag Calculate: Actual Subcooling = _ ..-..... . _. .._....._—__ ....�>.�..._._.._. ._......_. .... Tcondenser, sat - Tliquid Target Subcooling specified by manufacturer Calculate difference: Actual Subcooling - Target Subcooling = System passes if difference is between -4°F and +4°F Enter Pass or Fail 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 Caieulatee Actual Supern,eat-=A :.;'4 _.�: -.-- _ ..-..... . _. .._....._—__ ....�>.�..._._.._. ._......_. .... Tsuction - Tevaporator, saty Enter allowable superheat range fr6'm manufacturer's specifications (or use' -:;range between 3°F and 26°F if manufactur'r,'s specification is not available) System",passses�if*actual;;superheat is within 'h—e. allowable:superheatranget� Enter`Passuor. Fail ..- a. t i Reg: 211-A0054757A-M2500001A-M25A Registration Date/Time: 2011/12/05 21:47:04 HERS Provider: CalCERTS, Inc. 2008'Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5) Site Address: Enforcement Agency: Permit Number: 50740 GRAND TRAVERSE AVE, La Quinta CA 92253 City of La Quinta 11-1157 Standard Charge Measurement Summary: System shall pass both refrigerant charge criteria; metering device criteria (if applicable), and minimum cooling coil airflow criteria based on measurements taken concurrently during system operation. If corrective actions were taken, all applicable verification criteria must be re -measured and/or recalculated. System Name or Identification/Tag - Danielle Garcia 1686310 HERS Provider Data Registry Information Sample Group # (if applicable): 267786 System meets all refrigerant charge and airflow not-tested/verified dwelling in la HERS sample group requirements. HERS Rater Company Name: Energy Driven Solutions, Inc. Responsible Rater's Name: Responsible Rater's Signature: Enter Pass or Fail David Bricker Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 12/1/2011 CC2004132 DLARATION STATEMENT EC 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 raterwho 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) HARRISON ENTERPRISES INC Responsible Person's.Name: CSLB License: Danielle Garcia 1686310 HERS Provider Data Registry Information Sample Group # (if applicable): 267786 ❑ tested/verified dwelling not-tested/verified dwelling in la HERS sample group HERS Rater Information CaICERTS Certificate # CCl-1798601445 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: 12/1/2011 CC2004132 Reg: 211-A0054757A-M2500001A-M25A Registration Date/Time: 2011/12/05 21:47,:04 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: 50740 GRAND TRAVERSE AVE, La Quinta CA 92253 Enforcement Agency: Permit Number: (System 1) - City of La Quinta. 11-1157 Enter the .Duct,Systern Name or Identification/Tag: System 1 Enter the Duct System Location or Area Served: Whole House Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the dwelling. This installation certificate is required for compliance for alterations and additions in existing dwellings to space conditioning systems and duct systems. Note: For existing dwellings, a completely new or replacement duct system can also include existing parts of the original duct system (e.g., register boots, air handler, coil, plenums, etc.) if those parts are accessible and they can be sealed. For a completely new or replacement duct system installed in an existing dwelling; use the Installation Certificate titled 'Duct Leakage Test - Completely New or Replacement Duct System. " Duct Leakage Diagnostic Test - existing duct system Select one compliance method from the following four choices.' © 1. Measured leakage less than 156/b of fan flow b:.� .,Measured.leakage to outside less.than._106 p 3. Reduce leakage by 60% and conduct smoke and fix all leaks 4:, Fix all accessible leaks using smoke and HERS rater verify Note: '(One of Options 1, 2 or 3 mustz'.tie„attempted before utilizing Option,4.) Determine nominal'"=Fah�,Flow using one of#the�followingnthreecalculation methods �� �k.nn. a ✓ Cooling system method: Size of condenser in Tons 5 �x 400 2000 CFM ” w k 3 ✓ � Heang;system method- 21­ZNi, Output Capaat buza Pnr�-- CFM •. . ✓ O Measure) s stem rf(ow usin RA3 IairFlow test q lures -r CFM Y angr P� OptioiiAused then ��€ � � ` � ����� ; � �� '��'� 1 Allowed leakage = Fan Airflow 2000" x`0:1'5 300 ' CFM Actual Leakage); 110 CFM Pass if Actual Leakage is less than Allowed leakage Pass Fail Option2 used then:.:;. 4; 2 Allowed leakage = F"'WrfloWgi! x 0.10 = _ CFM Actual Leakage to outside.= 21E&M `,.;.,Pass if Actual leakage to outside is less than Allowed leakagePass 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 Ej Fail Option 4 used then: 4 All accessible leaks repaired using smoke test. HERS rater must verify (No Sampling). • Pass if all accessible leaks have been repaired. using smoke Ej Pass El Fail Reg: 211-A0054757A-M2100001A-0000 Registration Date/Time: 2011/12/05 21:23:40 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE. CF-6111-MECH-2I-HERS Duct Leakage Test - Existing Duct System (Page 2 of 2) Site Address: 50740 GRAND TRAVERSE AVE, La Quinta CA 92253 Enforcement Agency: Permit Number: (System 1) City of La Quinta } 11-1157 2 Outside air (OA), ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off during duct leakage_. testing. CFIK,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 posifi' h during duct leakage testing. All supply and return register boots musttie sealedtothesdrywall Ifsmo'ke test u�tlllzercompliance - applies to dutt leakage compliancdeFo tor3'(leak ge reductlon' by 6�%)hand option 4 (nfx all accessible leaks) described above: ° .r te M.- a . ...:. -, 0 New duct!installatlons,�dan ngt,�utllieeNbuild 0 Mastic and,drew-bandsmust b$eusedmcornbinatlon with4eloth backed rubber adhesle duct tape to seal leaks at all new duct connectlons� . DECLARATION STATEMENT ". • I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. • I am eligible under Division 3 of"the Business and Professions Code to accept responsibility for construction, or an authorized representative of the person responsible for construction (responsible person). • I certify that the installed features, materials, components, or manufactured devices identified on this certificate (the installation) conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the enforcement agency. • I understand that a HERS rater will check the installation to verify compliance, and that that if such checking identifies defects, I am required to take corrective action at my expense. I understand that Energy Commission and HERS provider representatives will.also perform quality assurance checking of installations, including those approved as part of a sample group but not checked by a HERS rater, and if those installations fail to meet the requirements of such quality assurance checking, the required corrective action and additional checking/testing of other installations in that HERS sample group will be performed at my expense. I reviewed a copy of the Certificate of Compliance (CF -1R) form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF -1R that apply to the installation have been met. • I will ensure that a completed, signed copy, of this Installation Certificate shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy.of this Installation Certificate is required to be included with the documentation the builder .provides to the building owner at occupancy. I will ensure that all Installation Certificates will come from a HERS provider data registry for multiple orientation alternatives, and beginning October 1, 2010, for all low-rise residential buildings. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) HARRISON ENTERPRISES INC Responsible Person's Name: Responsible Person's Signature: Danielle Garcia Danielle Garcia CSLB License: Date Signed: Position With Company (Title): 686310 10/21/2011, Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? ❑ Yes ❑ No 11 Reg: 211-A0054757A-M2100001A-0000 Registration Date/Time: 2011/12/05 21:23:40 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: I Enforcement Agency: Permit Number: 50740 GRAND TRAVERSE AVE, La Quinta CA 92253 City of La Quinta 11-1157 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 Whole House 1 0 Yes ❑ No 5/16 inch (8 mm) access hole upstream of evaporative coil in the return plenum and labeled according to Figure in Section RA3.2.2.2.2. ❑ Yes 'o Yes--, -� No- "i. d4 5%16-ir,&,(&-r,, access -hole -downstream of evaporatiave- 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..r Enter Pass or Fail ✓ 0 Pass ✓ (-IFail - STMS'- Sensor on.the Evaporator,Coil _ System Name..di�ldentification/Tagl'tj ,,o '-Sy"stem;i^ 3 s ❑Yes The sensor is factory mstall,ed;'orRfield,installed according to,manufacturers _ Cl No P4 specifications, or islinstalled by methods/specifications'approved bythe Executive The sensor is factory installed, or field installed according to manufacturer's f * E r Director., 4 ❑ Yes The sensor wire i5 terminated with;a;standard mini plug suitable for,connection ar to No digital,thermometer<Thejsensor,mini lis to the;installirig#technician {, plug accessible and;the,HERS;raterwithouk changing the airflow through the condenser coil 5 1 [1 Yes 1 ❑ No The sensor measures the saturation temperature of the coil within 1.3 degrees F Yes to3, is a[pass. Enter N/A if STMS are not _T applicable: Otherwise enter Pass or;Fail ✓ ©N/A ✓ El Pass ✓ ❑Fail STMS - Sensor on the Condenser. Coil System Name or Identification/Tag System 1 The sensor is factory installed, or field installed according to manufacturer's 6 ❑ Yes ❑ No specifications, or is installed by methods/specifications approved by the Executive Director. The sensor wire is terminated with a standard mini plug suitable for connection to a 7 ❑ Yes ❑ No digital thermometer. The sensor mini plug is accessible to the installing technician and the HERS rater without changing the airflow through the condenser coil 8 ❑ Yes ❑ No IThe sensor measures the saturation temperature of the coil within 1.3 degrees F Yes to 6, 7, and 8 is a pass. Enter N/A if STMS are not _T ✓ ©N/A ✓ El Pass ✓ E] Fail applicable. Otherwise enter Pass or Fail Reg: 211-A0054757A-M2500001A-0000 Registration Date/Time: 2011/12/05 21:25:16 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: 50740 GRAND TRAVERSE AVE, La Quinta CA 92253. I City.of La Quinta 11-1.157 Standard. Charge MeasurementProcedure.(for use if•outdoor air dry-bulb is above 55°F) Procedures for determining Refrigerant Charge using the Standard Charge Measurement Procedure are available in Reference Residential Appendix RA3.2. As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional form(s) for any -additional systems in the dwelling as applicable. • The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure. • The system must meet minimum airflow requirements as prerequisite for a valid refrigerant charge test., • If outdoor air dry-bulb is 55°F or below, the installer must use the Alternate Charge Measurement Procedure. Space Conditioning Systems System Name or Identification/Tag System 1 (must be re -calibrated monthly) System Location or Area Served Whole House 101811 `� (mus be�recalib at d monthly) _ Outdoor Unit Serial # .5811F11143 Outdoor Unit Make Lennox Outdoor Unit Model XC21-060-230 s Nominal Cooling Capacity Btu/hr 59500 temperature (Treturn, wb) "., Jr _'Date of Verification Da 10-21-11 d Evaporator saturation temperatures>: Calibration of Diagnostic Instruments Date of Refrigerant Gauge Calibration,.'': 10-18-11 (must be re -calibrated monthly) Supply (ev&porat,6"' 1 ani dry Date of Th�e,rmocouple libration�' 101811 `� (mus be�recalib at d monthly) tmg) ;bulb ' Measured TemperatureSgtq�l-) --; ? L tem i''' �i� .`" "y System Name or Identification/Tag`J • Sys Supply (ev&porat,6"' 1 ani dry tmg) ;bulb ' temperature (TsuppiY,r�56 Return (evaporator -entering) air drykbiilb temperatu edTT� to n idb) �� Return (evaporator entering) air wdtbulb 63 temperature (Treturn, wb) "., Jr Evaporator saturation temperatures>: 50 (Tevaporator, sat) Condensor saturation temperature 100 r (Tcondensor, sat) Suction line temperature (Tsuction) 73 Liquid Line Temperature (Tliquid) 98 Condenser (entering) air dry-bulb 100 temperature (Tcondenser, db) Reg: 211-A0054757A-M2500001A-0000 Registration Date/Time: 2011/12/05 21:25:16 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 r ' INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5) Site Address: Enforcement Agency: Permit Number: 50740 GRAND TRAVERSE AVE, La Quinta CA 92253 City of La Quinta - 11-1157 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 21 using Treturn, wb and Treturn, db Calculate difference: Actual Temperature Split - 0 Target Temperature Split = Passes if difference is between -3°F and +3°F or, upon remeasurement, if between -3°F and PASS -100°F Enter Pass or Fail + N9te: Terz7peratuce.5plit..M2thgO CaLcelation is, not..necessary. if s�ctyal Cooling_ l _AiIt7Qw is..vP�'figg iisi�rg-one of the--.... ai;,�'�;c-,a'��asuFe�k-•nt��2c;+.-L-:9;,=ti°+etr'�;'�•-Refe�nc-e R•2sidentia!-d���i� •R;43:3:-�r-sct .�;'-Z�r»k,g ��ri �irE,`e:a-rs _ --.- measured, the value must be equdl;.rsto or greater than, the Calculated Minimum Airflow Requirement in the table below. ff Calculated Minimum Airflow Re , ement CFM q ( ) = Nominal Cooling Capacity (ton) X 300 (dm/ton) System NameIdent fication/Tag - r Sy em 1 k. a .. Calculated M.mimum Airflow Requirement (CFM) AN �, �, i �„'`s�Wz`. r:� Via; All MeasuredAirflow usingRA3 3procedures (CFM) 1d ¢ q ry� ...�'PJ�i�<9{';vFX sSx�l�:•'.�4�i��RYS�%.,�...b 3. �i�.v �.... ��.:i%... Rk', F'h:�ma?S'�iP�'X�l+t! � •"J e. '.:%.. � .... @� 4.: Passes if measured'airflow is gFeate"r'Mthan or`-'° x" equal to the calculated minimum airflow' requirem.ent!RK& 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 i Calculate: Actual Superheat = Tsuction - Tevaporator, sat Target Superheat from Table RA3.2-2 using Treturn, wb and Tcondenser, db Calculate difference: Actual Superheat - Target Superheat = System passes if difference is between -5°F and +5°F Enter Pass or Fail Reg: 211-A0054757A-M2500001A-0000 Registration Date/Time: 2011/12/05 21:25:16 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms, August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification.- Standard Measurement Procedure (Page 4 of 5) Site Address: Enforcement Agency: Permit Number: 50740 GRAND TRAVERSE AVE, La Quinta CA 92253 City of La Quinta 11-1157 Subcooling Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag System.i Calculate: Actual Subcooling = 2.0 Tcondenser, sat - Tliquid LI Target Subcooling specified by manufacturer 2.5 Calculate difference: -0.5 Actual Subcooling - Target Subcooling = System passes if difference is between w* PASS is } a -3°F and +3°F PASS �3�. # .t_ 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 i .Calculat6*.. TT i4q, 23:0 suction evaporator, sat Enter allowable superheat range fr6m manufacturer's specifications (or use eange 25 between 4°F and 25°F if manufacturers specification is not available) System passes if actual` superheat is -Within they_ allowable superheat rape w* PASS is } a r. EntecPassor Failfi �3�. # .t_ Reg: 211-A0054757A-M2500001A-0000 Registration Date/Time: 2011/12/05 21:25:16 HERS Provider: Ca10ERTS,.Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5) Site Address: Enforcement Agency: Permit Number: 50740 GRAND TRAVERSE AVE, La Quinta CA 92253 City of La Quinta 11-1157 Standard Charge Measurement Summary: System shall pass both refrigerant charge criteria, metering device criteria (if applicable)', and minimum cooling coil airflow criteria based on measurements taken concurrently during system operation. If corrective actions were taken, all applicable verification criteria must be re -measured and/or recalculated. System Name or Identification/Tag System 1 CSLB License: Date Signed: Position With Company (Title): System meets all refrigerant charge and airflow 10/21/2011 Is this installation monitored by.a Third Party Quality. Name of TPQCP (if applicable): requirements. • PASS Enter Pass or Fail q. DECLARATION STATEMENT • I certify under penalty of perjury, under the laws of the State of California, the information provided or. 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 i 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 perrnit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. I will ensure that all Installation Certificates will come from a HERS provider data registry for multiple orientation alternatives, and beginning October 1, 2010, for all low-rise residential buildings. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) HARRISON ENTERPRISES INC Responsible Person's Name: Responsible Person's Signature: Danielle Garcia Danielle Garcia CSLB License: Date Signed: Position With Company (Title): 686310 10/21/2011 Is this installation monitored by.a Third Party Quality. Name of TPQCP (if applicable): Control Program (TPQCP)? ❑ Yes ❑ No , , r Reg: 211-A0054757A-M2500001A-0000 Registration Date/Time: 2011/12/05 21:25:16 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 U .1 _A --005-Y-75-7 4— HVAC Field Data Sheet Pg s oft Client Name G ,S &/ ' ,0 0 c-� 7 i • job # i2 `/ 65 5 Date /'0 ;! -I- // Address 5'a -7 y O -Ta ,4 a c -e Sc- Ph # Technician(s) 3a --,J Permit # - / -- // �I Gauge/ Mermocouple Calibration Date LO -- 18- 0 Spat ( Package j Some Ducts Only j All Ducts Only (Orde rnw ofd) EqrdpmentData ZONE 1 ZOAW2 ZpNE3 ZONE4 System Location or Area Served Heating Equipment Make Heating Equipment Model ARI Reference Plumber fL280.uNos�rd o� —4�5L5 oc� 7v - .Keating Equipment AFUE----... Duct Location (attic, crawLspace, etr-) Duct R Value (ifducts were installed) 14 Heating Load 74, Heating Equipment Output Capacity oo 0 Condenser Make Condenser Model Size in Tons SEER &EER Cooling Load Cooling Capacity S 3-4, 0 1K Qt ZO & 21 Duct Tesdng Duct leakage pretest result 4=/� Dud Leakmge F'mal Result QACFM/tm to pass (6%) o (jigNFa11 PasswaII PtsslFafl Duct Leakage FSnal Result <60 CFM/tomo Pass (15%) Pa=JFA PassIFao PaSSIM PasOFA Pass using 60% leakage reduction? Pass using smoke and visual Inspection? MEGH22 or.WCa25 'womb coHAirjlow a Pan..i;;tDraw . Measured Air Volume from Flow Grid or Hood NEW DUCTS T 3S0 CPM/t= x Condenser Tons p CHANGWUT TaV3t 300 CFM/ion x condenser Tons Measured air greater than Target? (Y/N) Measured Fan Watt Draw Target: 0.58 watts/measured CFM = Measured Watts less than Target? (YA CAmftbt 0 Zoic EDS EneU Drim Sotutt m tnc HVAC Field Data Sheet Pg2 oft Client Name Z-/ SI B z 0 D c, job # 12 y b i7. Date /e? - 2 7 - M af_z5 Charge & AfrJlowZONE 1 ZONE2 ZONE 3 ZOA/E 4 Condenser Serial Number Supply air dry bulb temperature t 3 Return air dry bulb temperature -77 Return air wet bulb temperature ,6,3 Evaporator Saturation Temperature 5 Condenser Saturation Temperature le7o Suction Line Temperature 7_3 Liquid Line Temperature �I B Suction Pressure /yep Liquid Pressure 321 Actual Airflow Temperature Split 0 - Target Target Temperature Split from Table RA32-3 2 Passes if difference is t 3° of Target Temp (Y/N) Actual Subcooling (t 4° of Target to pass) Target Subcooling from Mfr. 2 Actual Superheat (3 to 26° to pass) 2-3 Outside air dry bulb temperature rov o AffW 96 -We h -1n Chmghig below 55` Actual Line Set length (ft) JI,4 Mfr's Standard Lime Set Length (ft) Length Difference = Correction Factor (ounces per foot) Target: Correction Factor x Length Difference System Charged to Target? (YM Other Data Minimum amps 3 Maximum amps 5-0 Breaker size Sa Compressor amps I . Return Static Pressure Supply Static Pressure Supply Air Wet Bulb Temperature • ALL APFLICABLE BOXES ON THISFORK MUST BE COMPLETED FOR HAQIJOIL NO EXCEPTIONS:' • copyrI& 0 2011 EDS Earl Driven 8olurion4 bm SMOKE AND CARBON MONOXIDE ALARM RETROFIT VERIFICATION o -d (C7 f -Tr. and I, (Print Property Owner's Name) (Tenant's Name - If same as Owner write "Same") who own and/or live in the dwelling located at: , $20'7 (Address) . e G --veiify-ttrat the-smoke--arrd--carbun--monoxide-alarms-required-bythe-Caffomia--Residential Code (CR -C) -i ave - been installed in the dwelling, incompliance with the code and with the manufacturer's instructions and further that they have been tested and do function properly. In an effort to enhance life safety within dwellings, CRC Section R314.6, R315.2 and CBC 420.4 require the retrofit of these alarms in existing dwellings when alterations, repairs or additions requiring a permit and exceeding $1,000 in value are made. Generally, the alarms must be hard wired (110 volt) with battery back-up and all alarms are to be interconnected. If the installation'of the alarms will require the removal of wall or ceiling finishes or there is no access by means of attic, basement or crawl space, then alarms may be solely battery operated and not interconnected. Alarms must be installed in all of the following locations within the existing dwelling: In all bedrooms (only require Smoke Alarms) ➢ Immediately outside of:each separate bedroom. (require Smoke and Carbon Monoxide Alarms) ➢ In each story level of the dwelling, including basements and habitable attic rooms (require Smoke and Carbon Monoxide Alarms) These safety devices must be installed by the time a final inspection is requested for your project. I understand the above requirements and certify that we now have smoke alarms and carbon monoxide alarms installed that comply. We agree to comply with the CRC. In regards to. smoke alarms, carbon monoxide alarms. 2III Signature of Owner Date ATTENTION OWNER - OCCUPANT: Signature of Tenant Date This is a Voluntary Smoke and Carbon Monoxide Alarm verification procedure. If you prefer a Building Inspector to perform the verification, you must arrange to have an adult present at the time of inspection. NOTE. This Verification is only used when normal access to the Interior of the dwelling by the City of: uilding Inspector Is not achieved during the course of project construction. It is normally used for projects such as re-rooring, re-sId/ng, patio covers, swimming pools and the like.