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11-0969 (MECH)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Td4t 4 4 Q" Application Number: 11-00000969 Property Address: 52820 EISENHOWER DR APN: 773-331-028-24 -000000- Application description: MECHANICAL Property Zoning: COVE RESIDENTIAL Application valuation: 8838 Applicant: Architect or Engineer: BUILDING & SAFETY DEPARTMENT BUILDING PERMIT LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professi n Is Code, and my License is in full force and effect. License Class:Q C20 License No.: 686310 XDate: // Contractor: _ BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: (_ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself 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, 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.). (_) I am exempt under Sec. , B.&P.C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: _ Lender's Address: LQPERMIT Owner: JOYCE KENNETH M & SANDRA B 52820 EISENHOWER DR LA QUINTA, CA 92253 Contractor: GENERAL AIR CONDITIONING 31170 RESERVE DRIVE THOUSAND PALMS, CA 92276 (760)343-7488 Lic. No.: 686310 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 9/08/11 OF LA WORKER'S COMPENSATION DECLARATION I hereby affym 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 become ubject to the workers' compensation laws of California, and agree that, if I should become su ct to the the compensation provisions of Section 3700 of the Labor Code, I shall forth th comply with those provisions. Date: ( Applicant: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. 1 . Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application, the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above i o ation 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 urposes. Gate: 4 8 Signature (Applicant or Agent): Application Number . . . . . 11-00000969 Permit . . . MECHANICAL Additional desc . Permit Fee . . . . 33.00 Plan Check Fee 8.25 Issue Date . . . . Valuation . . . . 0 Expiration Date 3/06/12 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 9.0000 EA MECH FURNACE <=100K 9.00 1.00 9.0000 EA MECH B/C <=3HP/100K BTU 9.00 ---------------------------------------------------------------------------- Special Notes. and Comments HVAC CHANGE OUT - (1) 13SEER/80AFUE SPLIT SYSTEM. 2010 CALIFORNIA CODES. September 8, 2011 9:15:16 AM AORTEGA. Other Fees . . . -------- . . . . . BLDG STDS ADMIN (SB1473) - - ----- 1.00 Fee summary Charged Paid Credited Due ----------------- Permit Fee Total ---------------------------------------- 33.00 .00 .00 33.00 Plan Check Total 8.25 .00 .00. 8.25 Other Fee Total 1.00 .00 .00 1.00 Grand Total 42.25 .00 .00 42.25 LQPERMIT Sim lifled Prescriptive Certificate of Compliance:- 2008 Residential HVACAIterations CF -IR -ALT -HVAC ` Climate Zones 10 to 15 of. Site Address: forcer Agent : Date: / 1 Permit q: Conditioned Floor Equipment T et List Minimum Efficient 2 Duct insulation requirement Area Thermostat ❑ Packaged Unit ❑ AFUE 80% ❑COP Over 40 ft of ducts added or Setback trrnace door Coil ❑SEER /3 ❑ HSPF replaced in unconditioned space Served by system (/f not already ndensing Unit tn ❑ EER _L _ ❑ Resistance ❑ R 6 (CZ 10-13) ❑ R 8 (CZ 14-15) sf present, must be installed) ) hen 1. Equipment Type: Choose the equipment being installed: if more than une system, use another CF -1 R -ALT -HVAC fur each system. 2. Minimum Equipment Efficiencies: 13 SEER, 78% AFUE, 7.7HSPF for typical residential systems. HERS VERIFICATION SUMMARY Listed below are four HVAC alteration Options. The installer decides what work is being done and picks one of the appropriate Options. Each Option lists the HERS measures that must be conducted. A copy of the forms shall be left on site for final inspection and a copy given to the homeowner. At final, the inspector verifies that the work listed on this form was in fact the work completed by the installer. The inspector also verifies that each appropriate CF -6R and registered CF -4R forms (no hand filled CF-4Rs allowed) are filled out and ed. Be Innin October 1, 2010, a re istered co of the CF -1R and CF -6R shall also be on site for final ins ection. - HVAC Changeout tI Required Forms: • All HVAC Equipment replaced CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems). MECH- 25 -HERS CF -41k forms: MECH- 21 and fors lits stems MECH-25 • Condenser Coil and /or CF 6R Forms: MECH-2 I -HERS and (for split systems) MECH 25 HERS • Indoor Coil and/or CF -411 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 Exempte0lorn. duct leakage testing if: 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 ❑ 3. Existing ducts stems are constructed, insulated or sealed with asbestos ❑ 2. New HVAC System Required Forms: with new • Cut s: al Chang outducting ducts: (all new ducting and all CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS 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, STMS, 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 Required Forms: • Includes adding or replacing more than 40 CF -6R forms: MECH-04, MECH-2I-HERS CF -4R forms: MECH-21 linear feet of duct in unconditioned space. For split system or packaged units: Duct leakage < 15 percent ❑ EXCEPTION: Existing ducts stems constntcted, 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 1 and 6 of the California Code of Regulations. • The design features identified on this Certificate of Compliance are consistent with the ' orm tion documented on other ppli' ompliance forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for appro at with t e periiiit application. Name: CD I (een UJO—ts 6n Si ture: Company:Date: 6 en,era.I 4%r Gond;1 _icon,` Address: _311-70 l2eSeiUe, &r,' ✓,!�, License: [Ci ty/State/Zip:7-�� � k �� G,q g9�7� Phone: 760-3 3-7494 CaICERTS - CF -1R Registration Page 1 of 1 Public dame Danielle Garcia logged in [Logout] [Home] Secure Home About Us rraining Rater Directory Forms CONGRATULATIONS Your CF -IR -ALT -HVAC Registration is complete! You may want to print this page for your records. Site Address: 52820 EISENHOWER La Quinta, CA 92253 CEC Registration: 211-A0046468A-00000000-0000 rR_1112_el T_I-1'VAr• rt try Livoc Tri nnxirmi nAn Copyright,!.; 2010 CaICERTS, htc. All ris his reserved. Revised: January H. 2010 [Terns and Conditions] [Privacy Statement] [Class Cancellation Policy] CaICERTS, Inc., 31 Natoma St Suite 120, Folsom, CA 95630 Office: 916-985-3400,Toll Free: 877-HERS-R8R, (877437-7787) Fax: 916-985-3402 Contact Us rtttr 'gyp BBB 1,in-sat, Facebook�': https://www.calcerts.com/public_cflR.cfm?project_id=136549 9/7/2011 Assigned Company: JHARRISON ENTERPRISES INC Membership Benefits Do you know your HERS Rater? Events If you do, you may want to send this CF -1 R to them. - Industry Partners CaICERTS Rater ID: OR News My Rater Quick Select:'! Energy Driven Solutions, Ince Every CaICERTS rater has a license number. To register for our If you need to find the rater by name [Click HERE] to search our directory. monthly .-,- SEND.PF71RTO HERS -RATER newsletter, please click here. [CLICK HERE] to do another Copyright,!.; 2010 CaICERTS, htc. All ris his reserved. Revised: January H. 2010 [Terns and Conditions] [Privacy Statement] [Class Cancellation Policy] CaICERTS, Inc., 31 Natoma St Suite 120, Folsom, CA 95630 Office: 916-985-3400,Toll Free: 877-HERS-R8R, (877437-7787) Fax: 916-985-3402 Contact Us rtttr 'gyp BBB 1,in-sat, Facebook�': https://www.calcerts.com/public_cflR.cfm?project_id=136549 9/7/2011 Bin # Oty Of La Q[,uInta Building w Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinla, CA 92253 - (760). 777-7012 Building Permit -Application and. Tracking Sheet Permit # Project Address: S�g� & $en A.&W 4e,,L�� Owner's Name: A. P. Number: Address: !�C PJ219 �ii Legal Description: Contractor: City, ST, Zip: L4L (- Telephone: Address:—:37 t CID "S)r Project Description: 3 `"rZjy1#-G City, ST, Zip:' -7 Telephone State Lie. #: 3 L City Lie. C Arch., Engr., Designer: Address: City., ST, Zip: Telephoner. '`jc:: State Lie. #:'` ,.,. �`•-;;i�G,!��•• � Construction Type: Occupancy: `Project type (circle one): New Add'n Alter Repair Demo . Name of Contaet•Person: CO G(.G ert Sq. FL:# Stories: # Units: Telephone # of Contact Person: - �$ Estimated Value of Project: APPLICANT: DO NOT WRITE. BELOW THIS LINE # Submittal Req'd Recd TRACIONG PERMIT FEES Plan Sets . Plan Check submitted q; Item Amount Structural Cafes. Reviewed, ready for corrections Plan Check Deposit Truss Cales. Called Contact Person Plan Check Balance • Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading"plan 2ad Review, ready for correctionsAssue Electrical Subcontactor List Called Contact Person Plumbing . Grant Deed Plans picked up. S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- 7rd Review,.ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person Pub. Wks. Appr Date of permit issue l School Fees Total Permit Fees CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-21 Duct Leakage Test — Existing Duct System (Page 1 of 2) Site Address: Enforcement Agency: Permit Number: 52820 EISENHOWER, La Quinta CA 92253 (System 1) City of La Quinta 11-0969 Enter the Duct System Name or Identification/Tag: Enter the Duct System Location or Area Served: Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the dwelling. This installation certificate is required for compliance for alterations and additions in existing dwellings to space conditioning systems and duct systems. Note: For existing dwellings, a completely new or replacement duct system tan 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 Jess 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 caIculation,methodas. S, a �..-. a 'n r, . ✓ E] Cooling system method: Size of condenser in Tons 7 x 400 _') CFM system �. ✓ y ❑ Heat ng system method:'21.7`x _ Output Capaci in Thousand of Btu/hr. _ _CFM , ✓ airflow ❑Measured system airflow using RA3.3 test procedures: CFM Option 1 used then: I.' ... k, 1 Allowed leakage = Fan Flow r x 0.15 = _ CFM Actual Leakage = _ CFM Pass if Leakage Actual is less than Allowed rl Pass Fail Option 2 used then: 2 Allowed leakage = Fan Flow x 0.10 = _ CFM Actual Leakage to outside =7— 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 > 600/a 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 0 Pass Fail Reg: 211-A0046468A-M2100001A-M21A Registration Date/Time: 2011/10/14 20:26:22 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: Enforcement Agency: Permit Number: 52820 EISENHOWER, La Quinta CA 92253 (System 1) City of La Quinta 11-0969 ❑ 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�andxreturn register boots mustTbe,sealed to;the drywall,if•smokeitest,iszutilized for. com pl ia n ce - applies to duct leakage compliance,option 3°(leakage reduction by"60%j and'optiori.4.(fix allvaccessible leaks) described above. ❑ New duct installations cannot utilize building Cavities as plenums or platform returns, in Ileu of ducts:.r^+ ,^ ❑ Mastic and,draWbarids must be,used iWcombination;with cloth becked9rubber adhesive:duct tapho k5i j . 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 -1R) approved by the local enforcement agency. • The information reported on applicable sections of the Installation Certificate(s) (CF -611), signed and submitted by the person(s) responsible for the installation conforms to the requirements specified on the 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) HARRISON ENTERPRISES INC Responsible Person's Name: CSLB License: Danielle Garcia 1686310 HERS Provider Data Registry Information Sample Group # (if applicable): 254411 ❑ tested/verified dwelling 0 not-tested/verified dwelling in la HERS sample group HERS Rater Information CaICERTS Certificate # CC1-1798590490 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: 10/13/2011 CC2004131 Reg: 211-A0046468A-M2100001A-M21A Registration Date/Time: 2011/10/14 20:26:22 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page i of 5) Site Address: Enforcement Agency: Permit Number: 52820 EISENHOWER, La Quinta CA 92253 City of La Quinta 11-0969 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 SuuDIv and Return Plenums of Air Handler System Name or Identification/Tag `' . �' / ~ - i �+ L System Location or Area Served ❑ Yes 1 ❑ Yes ❑ No 5/16 inch (8 mm) access hole upstream of evaporative coil in the return plenum and labeled according to.Figure in Section,RA3.2.2.2.2. 2 ❑ Yes ❑ No 5/16 inch (8 mm) access hole downstream of evaporative coil in the supply plenum and labeled according to Figure in Section RA3.2.2.2.2. Yes to 1.and 2 is a pass. Enter Pass or Faill ✓ ❑ Pass ✓ ❑Fail STMS - Sensor on;the. Evaporator Coil System Name or Identification/Tag `' . �' / ~ - i �+ L 3 ❑ Yes ,(p No �'� The sensor is factory installed, orifield installed according to'manufacturer's specifications, or is installed by methods/specifications approved bythe Executive' - Director. _...—.N 4 ❑ Yes tj n ❑ 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 the insialling;tecKniciaA ' Director. and the HERS rater without changing the airflow through the condenser coil 5 ❑ Yes.-----� _.. — ❑ No +. I 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 applicable. Otherwise enter Pass or Fail ✓ ❑ N/A ✓ ❑ Pass ✓ ❑ Fail a 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 Y' p N/A ✓ ❑Pass ✓ E] Fail applicable. Otherwise enter Pass or Fail Reg: 211-A0046468A-M2500001A-M25A Registration Date/Time: 2011/10/14 20:35:29 HERS Provider: CalCERTS, 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 S) Site Address: Enforcement Agency: Permit Number: 52820 EISENHOWER, La Quinta CA 92253 1 City of La Quinta 11-0969 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 form(s) for any additional systems in the dwelling as applicable. • The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure. • The system must meet minimum airflow requirements as prerequisite for a valid refrigerant charge test. • If outdoor air dry-bulb is 55°F or below, the installer must use the Alternate Charge Measurement Procedure. Space Conditioning Svstems System Name or Identification/Tag (must be re -calibrated monthly) Date of hermocouple,Calibratiion y System Location or Area Served 4 Outdoor Unit Serial # Outdoor Unit Make Outdoor Unit Model Nominal Cooling Capacity Btu/hr r Date of Verification ,i l.allorailon or Ulagnosvc lnsirumenxs Date of Refrigerant Gauge Calibration M (must be re -calibrated monthly) Date of hermocouple,Calibratiion y (must bey calibrated monthly) 4 Measurea Temperatures'( -F) i I It -f.• I -C ] %I System Name or Ideyntification/Tag' Supply (evaporator leaving) air dry-bulb temperature (Tsupply, db) Return (evaporator entering) air dry-bulb temperature (Treturn, db) s Return (evaporator entering) air wet -bulb temperature (Treturn, wb) I Evaporator saturation temperature (Tevaporator, sat) Condensor saturation temperature (Tcondensor, sat) Suction line temperature (Tsuction) Liquid Line Temperature (Tliquid) Condenser (entering) air dry-bulb temperature (Tcondenser, db) Reg: 211-A0046468A-M2500001A-M25A Registration Date/Time: 2011/10/14 20:35:29 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 0 INSTALLATION CERTIFICATE CF-411-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5) Site Address: Enforcement Agency: Permit Number: 52820 EISENHOWER, La Quinta CA 92253 City of La Quinta 11-0969 Minimum Airflow Requirement Temperature Split Method Calculations for determining Minimum Airflow Requirement for Refrigerant Charge Verification. The temperature split method is specified in Reference Residential Appendix RA3.2. System Name or Identification/Tag Calculate: Actual Temperature Split = Treturn, db - Tsupply, db Target Temperature Split from Table RA3.2-3 using Treturn, wb and Treturn, db Calculate difference: Actual Temperature Split - Target Temperature Split = Passes if difference is between -4°F and +4°F or, upon remeasurement, if between -4°F and -100°F Enter Pass or Fail Note: Temperature Split Method Calculation is not necessary if actual Cooling Coil Airflow is verified using one of the airflow measurement procedures specified -in -Reference Residential Appendix RA3.3. If actual cooling coil airflow is measured, the value must be equal to or greater than the Calculated Minimum Airflow Requirement in the table below. i Calculated Minimum Airflow Requirement (CFM) = Nominal Cooling Capacity (ton) X 300 (cfm/ton) System NameTor=I"dentification/Tagt -, F.: Calculated Minimum Airflowllk quirement (CFM) Measured Airflow using RA3.3 procedures (CFM) 'N .�f J . -I f , % a 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 Reg: 211-A0046468A-M2500001A-M25A Registration Date/Time: 2011/10/14.20:35:29 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-4R-MECH-2! Iefrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5' Site Address: Enforcement Agency: Permit Number: 52820 EISENHOWER, La Quinta CA 92253 1 City of La Quinta 11-0969 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 Calculate: Actual Superheat = Tsuction - Tevaporator, sat Enter allowable superheat range from manufacturer's specifications (or use range between 3°F and 26°F if manufactur_er's specification is not available) t_ _ System passes -if actual'superheat is"within the r allowablesuperheat ange Enter Pass or Fail Reg: 211-A0046468A-M2500001A-M25A Registration Date/Time: 2011/10/14 20:35:29 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: 52820 EISENHOWER, La Quinta CA 92253 1 City of La Quinta 11-0969 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): 254411 System meets all refrigerant charge and airflow 0 not-tested/verified dwelling in la HERS sample group requirements. HERS Rater Company Name: Energy Driven Solutions, Inc. Responsible Rater's Name: Responsible Rater's Signature: Enter Pass or Fail David Bricker Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 10/13/2011 CC2004131 R - DECLARATION STATEMENT] • I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. • I am the certified HERS rater who performed the verification services identified and reported on this certificate (responsible rater). • The installed feature, material, component, or manufactured device requiring HERS verification that is identified on this certificate (the installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified on the Certificate(s) of Compliance (CF -1R) approved by the local enforcement agency. . The information reported on applicable sections of the Installation Certificate(s) (CF -6R), signed and submitted by the person(s) responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -SR) 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): 254411 ❑ tested/verified dwelling 0 not-tested/verified dwelling in la HERS sample group HERS Rater Information CalCERTS Certificate. # CC1-1798590490 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: 10/13/2011 CC2004131 Reg: 211-A0046468A-M2500001A-M25A Registration Date/Time: 2011/10/14 20:35:29 HERS Provider: Ca10ERTS, 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: Enforcement Agency: Permit Number: 52820 EISENHOWER, La Quinta CA 92253 (System 1) City of La Quinta 11-0969 Enter the Duct System Name or Identification/Tag: System 1 Enter the Duct System Location or Area Served: Whole House Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the dwelling. This installation certificate is required for compliance for alterations and additions in existing dwellings to space conditioning systems and duct systems. Note: For existing dwellings, a completely new or replacement duct system can also include existing parts of the original duct system (e.g., register boots, air handler, coil, plenums, etc.) if those parts are accessible and they can be sealed. For a completely new or replacement duct system installed in an existing dwelling, use the Installation Certificate titled "Duct Leakage Test - Completely New or Replacement Duct System. " Duct Leakage 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 leaks using smoke and HERS rater verify Note: (One of Options 1, 2 or 3 must -be attempted before utilizing Option 4.) Determine nominal-TFan;Flow using one-of.the following;thcee,calculation,methods. ir- .-yf ✓ 0 Coolinfgrsystemethod: Size of co a ser in Tons 4 x 400,= 1600\C"CFMV ✓ ❑ Heating system method 21.7 x'_ Output Capacity in Th&sa(n.ds of Btu/hr. =_— ✓❑ Measured system airflow using RA3.3 airflow Aest;procedures: CFM Option 1,used then:._ '= 1 Allowed leakage Fan Airflow` 1600 x 0.15 = 240 CFM Actual Leakage = 214 CFM t,. J Pass if Actual Leakage is less than Allowed leakage M Pass Fail Option 2 used then: 2 Allowed leakage = Fan Airflow x 0.10 = _ CFM Actual Leakage to outside = 1_:_--C—FM I Pass if Actual leakage to outside is less than Allowed leakage Pass ElFail 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% _ /b Reduction Pass if % Reduction > 60% o 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 Reg: 211-A0046468A-M2100001A-0000 Registration Date/Time: 2011/10/14 19:28:18 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: Enforcement Agency: Permit Number: 52820 EISENHOWER, La Quinta CA 92253 (System 1) City of La Quinta 11-0969 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. S © All supply andxreturn register boots must= be, sealed.to-the drywall.ifsmoke test-.is,utilizecl.=for compliance - applies to"duct leakage compliance opti n 3`(leakage reduction by 60%)za`nd,option,4,(flx all 6ccessible leaks) described above. • New duct installations cannot utilize building cavities as plenums or platform returns. in,lleu`of•ducts ---- 5 • Masticc'and.draw bands must be used in.combinatioWwith cloth backed rubber adhesiveduct tape,to seal leaks at all new duct connections _ r • �*- DECLARATION STATEMENT J • 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 9/9/2011 Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? ❑ Yes ❑ No Reg: 211-A0046468A-M2100001A-0000 Registration Date/Time: 2011/10/14 19:28:18 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: 52820 EISENHOWER, La Quinta CA 92253 1 City of La Quinta 11-0969 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 Q Yes ❑ No 5/16 inch (8 mm) access hole upstream of evaporative coil in the return plenum and labeled according to Figure in Section RA3.2.2.2.2. 2 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.l.and 2 is a pass. Enter Pass or Fail ✓ 0 Pass ✓ ❑ Fail STMS' Sensor on -the Evaporator.Coil System'Nameorldentification/Tagd System 1— -. �� h'` r.he 3 ❑ Yes p Nod- The sensor is factory installed, or -field installed according to manufacturer's specifications, or is4instal1e18,by methods/specifications approved by the Executive 6 ❑ Yes ❑ No Director. 'S —,� . �• 4 ❑ Yes t ;,+ i No The sensor wire is terminated with a standard'mini plug suitable for connection to a f; digital thermometer, The -sensor mini plug is accessible to;the installin technician•.; 7 I., ❑ No and the HERS rater without changing the airflow through the condenser coil 5 1 ❑ Yes I ❑ No The sensor measures the saturation temperature of the coil within 1.3 degrees F Yes to 3; 4i -and 5 is a -pass. Enter N/A if STMS are not applicable. Otherwise enter Pass or; Fail ✓ p N/A ✓ ❑ Pass ✓ ❑ Fail STMS - Sensor on the Condenser Coil System Name or Identification/Tag System 1 The sensor is factory installed, or field installed according to manufacturer's 6 ❑ Yes ❑ No specifications, or is installed by methods/specifications approved by the Executive Director. The sensor wire is terminated with a standard mini plug suitable for connection to a 7 ❑ Yes ❑ No digital thermometer. The sensor mini plug is accessible to the installing technician and the HERS rater without changing the airflow through the condenser coil 8 ❑ Yes ❑ No IThe sensor measures the saturation temperature of the coil within 1.3 degrees F Yes to 6, 7, and 8 is a pass. Enter N/A if STMS are not ✓ p N/A ✓ ❑Pass ✓ ❑Fail applicable. Otherwise enter Pass or Fail ig Reg: 211-A0046468A-M2500001A-0000 Registration Date/Time: 2011/10/14 19:29:49 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5) Site Address: Enforcement Agency: Permit Number: 52820 EISENHOWER, La Quinta CA 92253 City of La Quinta 11-0969 Standard Charge Measurement Procedure (for use if outdoor air dry-bulb is above 55°F) Procedures for determining Refrigerant Charge using the Standard Charge Measurement Procedure are available in Reference Residential Appendix RA3.2. As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional form(s) for any additional systems in the dwelling as applicable. • The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure. • The system must meet minimum airflow requirements as prerequisite for a valid refrigerant charge test. • If outdoor air dry-bulb is 55°F or below, the installer must use the Alternate Charge Measurement Procedure. Space Conditioning Systems System Name or Identification/Tag System i (must be re -calibrated monthly) System Location or Area Served Whole House be re -calibrated monthly) Outdoor Unit Serial # 1107711572 Outdoor Unit Make Amana - Outdoor Unit Model ASXC16048113A Nominal Cooling Capacity Btu/hr 48000 Date of Verification 9-9-11 Calibration or ulagnostic instruments Date of Refrigerant Gauge Calibration 9-1-11 (must be re -calibrated monthly) Date of T� rmocouple Calibrationust be re -calibrated monthly) Supply (evaporator leaving) airdry-bulb' 54 Measured TemperaturesiffF) i ; I -T. I "1?1 I IL lh System Name or Identification/Tag System 1 Supply (evaporator leaving) airdry-bulb' 54 temperature'(Tsupply, db) ) - Return (evaporator entering) air dry-bulb 77 temperature (Treturn, db) I Return (evaporator entering) air wet -bulb 59.7 temperature (Treturn, wb) f Evaporator saturation temperature 43 (Tevaporator, sat) Condensor saturation temperature 106 (Tcondensor, sat) Suction line temperature (Tsuction) 63 Liquid Line Temperature (Tliquid) 100 Condenser (entering) air dry-bulb 95 temperature (Tcondenser, db) Reg: 211-A0046468A-M2500001A-0000 Registration Date/Time: 2011/10/14 19:29:49 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 6 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5) Site Address: Enforcement Agency: Permit Number: 52820 EISENHOWER, La Quinta CA 92253 City of La Quinta 11-0969 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 i Calculate: Actual Temperature Split = Treturn, 23.00 db - Tsupply,db Target Temperature Split from Table RA3.2-3 22 using Treturn, wb and Treturn, db Calculate difference: Actual Temperature Split - 1 Target Temperature Split = Passes if difference is between -3°F and +3°F or, upon remeasurement, if between -3°F and PASS -100°F Enter Pass or Fail Note: Te.�nperature Split Method Calculation is not necessary, if actual Cooling. Coil Aflo irw.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 ,�' ,"' system,i Calculated Minimum Airflow -Requirement (CFM) '" E yy Measured:Airflosing RA3.3 procedures (CFM) , - Passes if measured airflow is greater than or equal to the calculated minimum airflow requirement:--- ` Enter Pass or Fail Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for fixed orifice metering device systems System Name or Identification/Tag System 1 Calculate: Actual Superheat = Tsuction - Tevaporator, sat Target Superheat from Table RA3.2-2 using Treturn, wb and Tcondenser, db Calculate difference: Actual Superheat - Target Superheat = System passes if difference is between -5°F and +5°F Enter Pass or Fail Reg: 211-A0046468A-M2500001A-0000 Registration Date/Time: 2011/10/14 19:29:49 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-611-MECH-25-HERE tefrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5, Site Address: Enforcement Agency: Permit Number: 52820 EISENHOWER, La Quinta CA 92253 1 City of La Quinta 11-0969 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 = 6.0 Tcondenser, sat - Tliquid Target Subcooling specified by manufacturer 6 Calculate difference: 0 Actual Subcooling - Target Subcooling = System passes if difference is between -3°F and +3°F PASS Enter Pass or Fail PASS 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 25 between 4°F and 25°F if manufacturer's specification is not available) Y System passes,if-actual'superheat is within the allowable superheat range PASS I ,., Enter Pass or Fail t Reg: 211-A0046468A-M2500001A-0000 Registration Date/Time: 2011/10/14 19:29:49 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: 52820 EISENHOWER, La Quinta CA 92253 1 City of La Quinta 11-0969 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 i CSLB License: Date Signed: Position With Company (Title): System meets all refrigerant charge and airflow 9/9/2011 Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): requirements. PASS Enter Pass or Fail i 3 DECLARATION STATEMENT • I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. • I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized representative of the person responsible for construction (responsible person). • I certify that the installed features, materials, components, or manufactured devices identified on this certificate (the installation) conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the enforcement agency. • I understand that a HERS rater will check the installation to verify compliance, and that that if such checking identifies defects, I am required to take corrective action at my expense. I understand that Energy Commission and HERS provider representatives will also perform quality assurance checking of installations, including those approved as part of a sample group but not checked by a HERS rater, and if those installations fail to meet the requirements of such quality assurance checking, the required corrective action and additional checking/testing of other installations in that HERS sample group will be performed at my expense. • I reviewed a copy of the Certificate of Compliance (CF -111) form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF -111 that apply to the installation have been met. • I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. I will ensure that all Installation Certificates will come from a HERS provider data registry for multiple orientation alternatives, and beginning October 1, 2010, for all low-rise residential buildings. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) HARRISON ENTERPRISES INC Responsible Person's Name: Responsible Person's Signature: Danielle Garcia Danielle Garcia CSLB License: Date Signed: Position With Company (Title): 686310 9/9/2011 Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? ❑ Yes ❑ No Reg: 211-A0046468A-M2500001A-0000 Registration Date/Time: 2011/10/14 19:29:49 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms August 2009 a SMOKE AND CARBON MONOXIDE ALARM RETROFIT VERIFICATION I, k<� 00— �,C-L 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: , 572 84 0 (Address) c N S .2 ; 3 verify that the smoke and carbon monoxide alarms required by the California Residential Code (CRC) have been installed in the dwelling, incompliance with the code and with the manufacturer's instructions and further that they have beers 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 (I 10 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 understanct:the above requirements and certify that we now have smoke alarms and carbon monoxide alarms inst Iled that com)7Z ply. We agree to omply with the CRC. in regards to. smoke alarms, carbon mono ide arm Signature of Ownor---J--11 i Date Signature of Tenant Date ATTENTION 0111/NLFR - OCCUPANT: This is a Voluntary Smoke and Carbon Monoxide Alarm verification procedure. If you prefer a Building Inspector to perform the verification, you must arrange to have an adult present at the time of inspection. NOTE: This Verification is only used when normal access to the interior of the dwelling by the City of: uilding Inspector is not achieved during the course of project construction. It is normally used for projects such as re-roonng, re -siding, patio covers, swimming pools and the like.