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11-1070 (MECH)P.O. BOX 1504 78-495-CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: AM: Application description Property Zoning: Application valuation: 11.800001070 8609 TA TIERRA 646-081-005- - MECHANICAL' LOW DENSITY RESIDENTIAL 7850 • 0"' BUILDING.& SAFETY DEPARTMENT BUILDING PERMIT - Owner: , PETRONE ANTHONY J - 48609.VISTA TIERRA LA QUINTA, CA 92253 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 9/29/11 Contractor:. Applicant: Architect or Engineer: HYDES 42949 MADIO STREET q�c� OJJ ' . INDIO, CA 92201 (760) 360-2202 LiC. No.: 906115 ---------_------------- LICENSED CONTRACTOR'S DECLARATION - WORKER'S COMPENSATION DECLARATION hereby affirm under. penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations: Section 7000) of Division 3 of the Business and Profess' nals Code, and my License is in full force and. effect. I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided Licens lass: C20 6 ense No.: 906115 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ntractor: I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the workfor which this permit is issued. My workers' compensation R OWN -BUILDER DECLARATION ` insurance carrier and policy number are: I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier NORGUARD INS Policy Number CEWC243358 - - following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to- _ I certify that, in the performance of the work for which this permit is issued, I shall not employ any - construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to become subject to the workers' compensation laws of California, permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I should become subject then cers' compensation provisions of Section License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or - 3700 the Labor Code, I'shall fort w* omply th those provisions. " 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).:ate. IIcant: - (_ 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 WARNING: FAILURE TO SECURE WORKERS' COMPE SATION COVERAGE IS UNLAWFUL, AND SHALL Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED. THOUSAND 'and who does the work himself or herself through his or her own employees, provided that the . DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN ' improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST; AND ATTORNEY'S FEES.. 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.). APPLICANT ACKNOWLEDGEMENT (_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project*(Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the 7044, Business and Professions Code:: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application. . . property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed 1. Each person upon whose behalf this application is made, each person at whose request and for pursuant to the Contractors' State License Law.). - whose benefit work is'performed under or pursuant to any permit issued as a result of this application, (_ 1 I am exempt under Sec. , B.&P.C. for this reason 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. - Date: Owner: CONSTRUCTION LENDING AGENCY ' 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.I. Lender's Name: Lender's Address: 1 LQPERMIT 2. Any permit issued as a result of this application becomesnulland void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for, 180 days will subject permit to cancellation. - I. certify that I have read this application and state that the above information ' correct. I agree �Eomply with all city an county ordinances and state laws relating to building construction nd by auth a representatives oft c my to entF upon above-mentioned property for ' pectio u os J7 r Date:' nature (Applicant or Agent): 1 Application.Number . . . 11-00001070 Permit MECHANICAL. Additional desc . Permit Fee 40.50 Plan Check Fee 10.13 Issue Date . . Valuation . . . . 0 Expiration Date 3/27/12 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 ' HVAC CHANGE -OUT: INSTALL NEW FURNACE, INDOOR COIL,.CONDENSER. 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 LQPERMIT. - Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -IR -ALT -HVAC Climate Zones 10 - 15 Site Address: Enforcement Agency: Date: Permit #: 48-609 Vista Tierra La Quinta, CA 92253 City of La Quinta Sep 28, 2011 Duct insulation Conditioned Floor Equipment Type1 List Minimum Efficiency2 requirement Area Thermostat ❑ Package Unit p Furnace 0 AFUE 78% ❑ COP ❑ R 6 (CZ 10-13) Served system p Setback • Indoor Coil p SEER 13.0 C]HSPF El R 8 (CZ 14-15) 2000 sf If not already present, must be p Condensing Unit C] EER ❑ Resistance installed) ❑ Other 1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -IR -ALT -HVAC for each system. 2. Minimum Equipment Efficiencies: 13 SEER, 78% AFUE, 7.7HSPF for typical residential systems. HERS VERIFICATION SUMMARY Listed below are FOUR HVAC alteration Options. The installer decides what work is being done and picks one of the appropriate Options. Each Option lists the HERS measures that must be conducted. A copy of the forms shall be left on site for final inspection and a copy given to the homeowner. At final, the inspector verifies that the work listed on this form was in fact the work completed by the installer. The inspector also verifies that each appropriate CF -6R and registered CF -4R forms (no hand filled CF-4Rs allowed) are filled out and signed.Beginning October 1, 2010, a registered copy of the CF -111 and CF -611 shall also be on site for final inspection. D 1. HVAC Changeout Required Forms: . All HVAC Equipment CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS replaced CF -4R forms: MECH-21 and (for split systems) MECH-25 . Condenser Coil and /or . Indoor Coil and /or CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS . Furnace CF -4R forms: MECH-21 and (for split systems) MECH-25 For Split Systems: Duct, leakage <;15: percent; RC, CCA <_ 300 CFM/ton (Minimum Air Flow Requirement), TMAH Exempted from duct leakage testing ifc p 1 'Duct system was documented to have been previously sealed and confirmed through HERS verification, or ❑ 2. Duct systems with lessthan':40 linear feet in unconditioned space, or E] 3. Existing duct systems are constructed, insulated or sealed with asbestos ❑ 4. The ysternrwill not be Ducted (ie DuctlessHMim-SplitSystem) (AlsoExempt from-RefrigerantCharge) ❑ 2. New HVAC System Required,Forms_: w - . Cut in or Changeout with new ducts:' (all new i CF 6R fo kms ;MECH 04, MECH 20 HERS, and (for splitsystems) MEC H `22 HERS and MECH 25 HERS ducting and all new �. CF 4R m fors m MECH 20, and (for split systems) MECH-22, and MECH 25 equipment) I �. X ✓ ' For Split Systems:".;Duct leakage c,6 percentRC, ;CCA >_350 CFM/ton, FWD, TMAH; STM$, and either-HSPP or`PSPP. For Packaged Units: Duct leakage < 6 percent ❑ 3., New -Ducts with/or.without' ? Required Forms: Replacement .. . Includes replacing or installing all new ducting and/or outdoor condensing unit:arid/or indoor CF -6R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS coil and/or furnace. No or some equipment CF -4R forms: MECH-20 and (for split systems) MECH-25 changed. For Split Systems: Duct leakage < 6 percent; RC, CCA >_ 300 CFM/ton, TMAH For Packaged Units: Duct leakage < 6 percent ❑ 4. New Ducting over 40 feet Required Forms: . Includes adding or replacing more than 40 CF -6R forms: MECH-04, MECH-2I-HERS linear feet of duct in unconditioned space. CF -4R forms: MECH-21 For split system or packaged units: Duct leakage < 15 percent ❑ EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos. Contractor (Documentation Author's /Responsible Designer's Declaration Statement) . I certify that this Certificate of Compliance documentation is accurate and complete. . I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of Compliance. . I certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24, Parts 1 and 6 of the California Code of Regulations. . The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with the permit application. Name: Mark Hyde Signature: Mark Hyde Company: CERTIFIED COMFORT SYSTEMS INC Date: Sep 28, 2011 Address: 42-949 MADIO STREET License: 906115 City/State/Zip: INDIO / CA / 92201 Phone: (760) 360-2202 Reg: 211-A0050306A-00000000-0000 Registration Date/Time: 2011/09/28 13:37:35 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms July 2010 Bin # Permit # J l' `O `O now Project Address: A. P. Number: Contractor: Address: City, ST, Zip: n Telephone: G"Z� State Lic. # Arch., Engr., Designer: Address: City, ST, Zip: Telephone. State Lic_ #: Name of Contact Person. Telephone # of Contact Person: # Submittal Plan Sets Structural Calcs. Truss Calcs. Energy Calcs. Flood plain plan Grading, plan' Subcontactor List Grant Deed H.O.A. Approval IN HOUSE: - Planning Approval Pub. Wks. Appr School Fees City of La Quinta Building 8L Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Irlr`1 Owner's Name: Ilel 4 Te Address: :0— 609 City, ST, Zip: ��. Q /' J Project Description: �tZ1�i Lic. #: yl ei Total Permit Fees Construction Type: Occupancy: P cy: Project type (circle one): New Add'n Alter Repair' Demo Sq. Ft.: # Stories: # Units: Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE Rec'd TRACKING PERMIT FEES Plan Check submitted Reviewed, ready for corrections Item Amount Plan Check Deposit Called Contact Person Plan Check Balance Plans picked up Construction Plans resubmitted Mechanical 2°" Review, ready for correciions/issue Electrical Called Contact Person . Plumbing Plans picked up S.M.I. Plans resubmitted Grading 3w Review, ready for corrections/issue Developer Impact Fee Called Contact Person A.I.P.P. Date of permit issue Total Permit Fees CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4111-MECH-21 Duct Leakage Test — Existing Duct System (Page 1 of 2) Site Address: Enforcement Agency: Permit Number: 48-609 Vista Tierra, La Quinta CA 92253 (System 1) City of La Quinta 11-1070 Enter the Duct System Name or Identification/Tag: Enter the Duct System Location or Area Served: Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the dwelling. This installation certificate is required for compliance for alterations and additions in existing dwellings to space conditioning systems and duct systems. Note: For existing dwellings, a completely new or replacement duct system can also include existing parts of the original duct system (e.g., register boots, air handler, coil, plenums, etc.) if those parts are accessible and they can be sealed. For a completely new or replacement duct system installed in an existing dwelling, use the Installation Certificate titled "Duct Leakage Test - Completely New or Replacement Duct System." Duct Leakage Diagnostic Test - existing duct system Select one compliance method from the following four choices. ❑ 1. Measured leakage less than 15% of fan flow , ❑ 2. Measured leakage to outside.less than 10% of Fan Flow ❑ 3. Reduce leakage by 60% and conduct smoke and fix all leaks Ej 4. Fix all.accessible;leaks using smoke and HERS rater verify Notei(One of Options 1, 2, or 3 muskbe attempted before utilizing Option 4.) Determine nominal+F,,anjFlow using one of the following three,,calculationTmethods ❑ �' Coolins 9. Ystem method: Size of,c,f,c Tons�aondenser in 7 TM x 400 CFM '��FF`` [I .. It c� YT's",."...►++.. -.c— ✓ ❑Heating system.method: 21 7 x-> Output CapacityjinkThousands ofgBtu/hr = M ' _�CFIN ir° V q ✓❑Measured systemairfowAi. rflow3testxprSoc�Le.dues..' _• CFM. -<> Option.;i used then .�� c q Allowed -leakage' Flowx 0;15`CFM�� '^�_ �W' 1 ,'Fan M.,, Y`�,a Actual Leakage = CFM { .; r Pass if Leakage Actual is less than Allowed , ❑ Pass ❑ Fail Option 2 used then: b 2 Allowed' leakage Fan Flow -1x'0.10 = _ CFM Actual Leakage to outside.= L CFM rz:"=`:`-. - Pass if Leakage Actual is less than Allowed Pass El Fail Option 3 used then: Initial leakage prior to start of work = _ CFM Final leakage after sealing all accessible leaks using smoke test = _ CFM 3 Initial leakage _ - Final leakage _ = Leakage reduction_CFM ((Leakage reduction _ / Initial leakage _) x 100% _ Reduction Pass if % Reduction > 60% ❑ Pass Fail Option 4 used then: 4 All accessible leaks repaired using smoke. HERS rater must verify (No sampling). No smoke allowed to leak from system. Including ducts, plenums, air handler and door panel. Pass if all accessible leaks have been repaired using smoke ❑ Pass El Fail Reg: 211-A0050306A-M2100001A-M21A Registration Date/Time: 2011/10/11 15:17:03 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-21 Duct Leakage Test — Existing Duct System (Page 2 of 2) Site Address: Enforcement Agency: Permit Number: 48-609 Vista Tierra, La Quinta CA 92253 (System 1) City of La Quinta 11-1070 ❑ Outside air (OA) ducts for Ce h&!*'Fan Integrated'(CFI) ventilation systems, shall not be sealed/taped off during duct-Ieakagei'testing CFIbA 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 beconfigured•toahe closed position.during duct leakage testing. ❑'All supply �andkreturn register boots must besealedtotthe d.rywallaif�smo;kextestisautlllzed;for compliance — a pplles,to�yduct leakage compliance d"ption 3 (leakage,re'ductlomby_1:60%)) ndfoption 4 {fix all §'Lessible leaks) described above��"N x i ���' 4i �•.. � . e`` ,� �` « k �` .+ •,i' �$n � �a-w«...,,r ..".�,,,' a�•Y , ❑ New duct installations cannot utilize building cavities as plenumsk'or platform returns in lieu aogf ducts t.. u`M__r�..&" . aE .+'w.+r x s $ •, mP. P.� :4 n'd Y'• + a. ❑ Mastic andT.draw bands�mustlhe,used:=iny,combinatlon.wltnTclo�tri backed -rubber adhesive ductStapekto seal leaks at all`liew duct cOnfieCtl S'—,es� r DECLARATION STATEMENT I certify.under penalty of perjury, u tl er 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 (CF71R) 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 -SR) 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) CERTIFIED COMFORT SYSTEMS INC Responsible Person's Name: CSLB License: Mark Hyde .y HERS Provider Data Registry Information _ Sample Group # (if applicable): 251073 ❑ tested/verified dwelling R not-test,d/verified dwelling in ' ❑ Outside air (OA) ducts for Ce h&!*'Fan Integrated'(CFI) ventilation systems, shall not be sealed/taped off during duct-Ieakagei'testing CFIbA 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 beconfigured•toahe closed position.during duct leakage testing. ❑'All supply �andkreturn register boots must besealedtotthe d.rywallaif�smo;kextestisautlllzed;for compliance — a pplles,to�yduct leakage compliance d"ption 3 (leakage,re'ductlomby_1:60%)) ndfoption 4 {fix all §'Lessible leaks) described above��"N x i ���' 4i �•.. � . e`` ,� �` « k �` .+ •,i' �$n � �a-w«...,,r ..".�,,,' a�•Y , ❑ New duct installations cannot utilize building cavities as plenumsk'or platform returns in lieu aogf ducts t.. u`M__r�..&" . aE .+'w.+r x s $ •, mP. P.� :4 n'd Y'• + a. ❑ Mastic andT.draw bands�mustlhe,used:=iny,combinatlon.wltnTclo�tri backed -rubber adhesive ductStapekto seal leaks at all`liew duct cOnfieCtl S'—,es� r DECLARATION STATEMENT I certify.under penalty of perjury, u tl er 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 (CF71R) 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 -SR) 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) CERTIFIED COMFORT SYSTEMS INC Responsible Person's Name: CSLB License: Mark Hyde 1906115 HERS Provider Data Registry Information _ Sample Group # (if applicable): 251073 ❑ tested/verified dwelling R not-test,d/verified dwelling in ' a HERS sample group HERS Rater Information CalCERTS Certificate # CCI -1798595521 HERS Rater Company Name: Desert H.E.R.S. Raters Responsible Rater's Name: Responsible Rater's Signature: Michael Hyde Michael Hyde Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 9/14/2011 CC2005602 Reg: 211-A0050306A-M2100001A-M21A Registration Date/Time: 2011/10/11 15:17:03 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 5) Site Address: Enforcement Agency: Permit Number: 48-609 Vista Tierra, La Quinta CA 92253 1 City of La Quinta 11-1070 Note: If installation of a Charge Indicator Display (CID) is utilized as an alternative to refrigerant charge verification for compliance, a MECH-24 Certificate (instead of this MECH-25 Certificate) should be used to demonstrate compliance with the refrigerant charge verification requirement. TMAH and STMS are not required for compliance, when a CID is utilized for compliance. As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional form(s) for any additional systems in the dwelling as applicable. Temperature Measurement Access Holes (TMAH) and Saturation Temperature Measurement Sensors (STMS) Procedures for installing TMAH are specified in Reference Residential Appendix RA3.2. If refrigerant charge verification is required for compliance, TMAH are also required for compliance. STMS are only required for completely new or replacement space -conditioning systems that utilize prescriptive compliance method. TMAH - Access Holes in Supplv and Return Plenums of Air Handler System Name or Identification/Tag a T - _ °i i 4r, 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 n®No� xThe sensor�wi"reds terminated with a standard mingplug suitable for�connectibn, digitallthe"rmometerThe"sensor mmi plug is accessible Eo the mstallmg _techmcuan and'the HERS'gater,wlthout changing the°airflowAhrough the°condenser coil 5.) 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 ✓ El Pass ✓ ElFail ❑ Yes and labeled according to Figure in Section RA3.2.2.2.2. Yes to-l.,and.2-is a pass. __', Enter Pass or Faill ✓ ❑ Pass ✓ ❑Fail STMS'- Sensor.onxthe,Evaporator Coil , , : System Name'or,Identification/Tag' a T - _ °i i 4r, 3 ❑•Yes p No The sensor is factory installed or field&installed according to manufacturers. specifications, or is installed by methods/'specificat'ions,'approved by the Executive `<"_ Director.` Y` 4 ' rx ' 8'Yes n®No� xThe sensor�wi"reds terminated with a standard mingplug suitable for�connectibn, digitallthe"rmometerThe"sensor mmi plug is accessible Eo the mstallmg _techmcuan and'the HERS'gater,wlthout changing the°airflowAhrough the°condenser coil 5.) ❑Yes..- ❑ No When' attached' to a digital thermometer, the sensor provides an indication of the saturation ternperature of the coil. Yes to 3,, 4,. and -5. -is a pass. Enter N/A if_STMS are not applicable. Otherwise enter Pass orfail: ✓ [_1 N/A ✓ El Pass ✓ ElFail STMS - Sensor on the Condenser`Coil System Name or Identification/Tag The sensor is factory installed, or field installed according to manufacturer's ❑ 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 ❑ Yes ❑ No digital thermometer. The sensor mini plug is accessible to the installing technician Nacable. - and the HERS rater without changing the airflow through the condenser coil ❑ Yes ❑ No - When attached to a digital thermometer, the sensor provides an indication of the saturation temperature of the coil. 6, 7, and 8 is a pass. Enter N/A if STMS are not ©N/A ✓ ❑ Pass ✓ ❑ Fail Otherwise enter Pass or Fail .I I Reg: 211-A0050306A-M2500001A-M25A Registration Date/Time: 2011/10/11 15:20:11 HERS Provider: Ca10ERTS, 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: 48-609 Vista Tierra, La Quinta CA 92253 1 City of La Quinta 11-1070 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 Systems System Name or Identification/Tag (must be re -calibrated monthly) - y �'/- System Location or Area Served ., .v';. Date of ThermocouplerCalibration �:�� � , (must be rercalibrated monthly) Outdoor Unit Serial # Outdoor Unit Make Outdoor Unit Model Nominal Cooling Capacity Btu/hr Date of Verification l.anDrarion or ulagnostic instruments Date of Refrigerant Gauge Calibration (must be re -calibrated monthly) - y �'/- ., .v';. Date of ThermocouplerCalibration �:�� � , (must be rercalibrated monthly) Supply (evaporato'r leaving) -air dry-bulb measured 'remperaturesA-,-F) System Name or Ident fication/Tag ' , - y �'/- Supply (evaporato'r leaving) -air dry-bulb temperature'(T SuPPIY, db) Return (evaporator -entering) air dry-bulb temperature (Treturn, db! Return (evaporator entering) air wet -bulb temperature (Treturn, wb) Evaporator saturation temperature (Tevaporator, sat) Condensor saturation temperature (Tcondensor, sat) Suction line temperature (Tsuction) Liquid Line Temperature (Tliquid) Condenser (entering) air dry-bulb temperature (Tcondenser, db) Reg: 211-A0050306A-M2500001A-M25A Registration Date/Time: 2011/10/11 15:20:11 HERS Provider: CalCERTS, 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: 48-609 Vista Tierra, La Quinta CA 92253 City of La Quinta 11-1070 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. CalculatedAMinimum Airflow Requirement (CFM) = Nominal Cooling Capacity (ton) X 300 (cfm/ton) System Name or-Identification/Tag o r. j Calculated Minimum AirflowRequirement (CFM) '��'':=" TFZAd`3 Measured_Airflow using 3 procedures (CFM) : Passes -if measured airflow is greater:than or equal:'. -_ to the calculatedminimum 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-A0050306A-M2500001A-M25A Registration Date/Time: 2011/10/11 15:20:11 HERS Prcvider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-411-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5) Site Address: Enforcement Agency: Permit Number: 48-609 Vista Tierra, La Quinta CA 92253 City of La Quinta 11-1070 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 " _ -, ,jj. P�.>iF lF+. kF • �,3Q �wsY+ 4 .S;SeYrYr V s.. �3 �:.� 4 ao.y NN";++..�XY3i. i.... Metering Device Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag,+' ? Calculate: Actual Superheat ,= k ' Tsuction•-Tevaporator,sat4..'-' Enter -allowable superheat range from manufacturer's specifications W use range betty'een 30F and 26°F if manufactufer s; s ecification is not available P � .,, System passesaif actual superheat isrwithin the allowable superheatrange���� " Enter;Pass or Fail -,� - ._... A: t ... _ . -1. " _ -, ,jj. P�.>iF lF+. kF • �,3Q �wsY+ 4 .S;SeYrYr V s.. �3 �:.� 4 ao.y NN";++..�XY3i. i.... Reg: 211-A0050306A-M2500001A-M25A Registration Date/Time: 2011/10/11 15:20:11 HERS Provider: Ca10ERTS, Inc. .2008 Residential Compliance Forms March 2010 4 INSTALLATION CERTIFICATE CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5) Site Address: Enforcement Agency: Permit Number: 48-609 Vista Tierra, La Quinta CA 92253 City of La Quinta 11-1070 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 Mark Hyde 1906115 HERS Provider Data Registry Information Sample Group # (if applicable): 251073 System meets all refrigerant charge and air]orFail 0 not-tested/verified dwelling in la HERS sample group requirements. HERS Rater Company Name: Desert H.E.R.S. Raters Responsible Rater's Name: Responsible Rater's Signature:. Enter Pas Michael Hyde Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 9/14/2011 CC2005602 F i i •, ri , �. t '. w > "r ti .v }, r :., i�p;�w. ,:� r '°y '' �; � jrt� i. R,x B A. Jaf .may 1�%'' E 4 J C DECLARATION'S TATE MENTf } • I certify under penalty of perjury, under•the laws of the State of California, the information provided on this form is true and correct. • I am the certified HERS rater -who performed the verification services identified and reported on this certificate (responsible rater). The installed feature, material, component; or manufactured device requiring HERS verification that is identified on this certificate (the installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified on the Certificate(s) of Compliance (CF -111) approved by the local enforcement agency. r The information reported on applicable sections of the Installation Certificate(s) (CF -6R), signed and submitted by the person(s) responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -1R) approved by the anfnrramant nnanrv_ Builder or Installer information as shown on the Installation Certificate (CF -6R) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) CERTIFIED COMFORT SYSTEMS INC Responsible Person's Name: CSLB License: Mark Hyde 1906115 HERS Provider Data Registry Information Sample Group # (if applicable): 251073 ❑ tested/verified dwelling 0 not-tested/verified dwelling in la HERS sample group HERS Rater Information CalCERTS Certificate # CC1-1798595521 HERS Rater Company Name: Desert H.E.R.S. Raters Responsible Rater's Name: Responsible Rater's Signature:. Michael Hyde Michael Hyde Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 9/14/2011 CC2005602 Reg: 211-A0050306A-M2500001A-M25A Registration Date/Time: 2011/10/11 15:20:11 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-6R-MECH-04 Space Conditioning Systems, Ducts and Fans (Page 1 of 2) Site Address: . ' Enforcement Agency: Permit Number: 48-609 Vista Tierra, Le Quinta CA 92253 (System 1) City of La Quinta 11-1070 Space Conditioning Systems Heating Equipment •' ` I Cooling Equipment f r Efficiency Duct Equip Efficiency Location Equip r°` ` (AFUE, (attic, - Type 2F•` �` —CEC Certified Mfr. Name ARI' # of etc.)1, 3 _crawl- Duct Heating Heating (package- CEC Certified Mfr. Name Reference Identical (>=CF -1R space, Duct Load Capacity heat pump) and Model Number Number2 Systems value)4 etc.) R=value (kBtu/hr) (kBtu/hr) , Split american standard _ 4586904 jq 1 ,13_EERrK NAttie'* irR ,4.2 .,053VV, 55 kBtu Furnace aud2c100b9v5vba 1 80 AFUE Attic R-4.2 •80 100 kl3tu 11� :'"�.; a 4. `-. •AgrF x .iii... .�r. I Cooling Equipment f r Efficiency Duct t ' a 1. If project is new construction, see Footnotes to Standards Table 151-B and Table 151-C for duct ceiling alternative compliance. S' 2. ARI Reference Number can be found by entering the equipment model number at http://www.aridirectory.org/ari/ac:php# , 3. Listed efficiency on this page must be greater than or equal ( ? ) to the value shown on the CF -1R form. - 4. When CF -IR is reference it is also applicable to the CF -1R, CF -IR -AA or CF -1R -ALT ALL BOXES MUST BE CHECKED TO BE A VALID FORM - R §110-§113: HVAC equipment is certified by the California Energy Commission. Pj.§150(h): Heating and/or cooling loads calculated in accordance with ASHRAE; SMACNA, or ACCA.' E §150(i): Setback Thermostat on all applicable heating and/or cooling systems meet the requirements of §112(c). 1::.• ` 21 §150(j)2: Pipe insulation fortcooling system refrigerant suction, chilled water and brine lines meets minimum requirements of Table 150-B and includes a vapor retardant or is enclosed entirely in, . = conditioned space. ,' • • 4's.: i• •. •.. � e - • - • F' `' ` •. • • r •0.N * � • - 1' ' . . • r Reg: 211-A0050306A-M0400001A-0000, Registration Date/Time: 2011/10/05.18:59:46 'HERS Provider: Ca10ERTS, Inc. �2008,Residential Compliance Forms August 2009 Efficiency Duct Equip (SEER Location Type r°` ` and EER) (attic, (package, heat " 2F•` �` —CEC Certified Mfr. Name ARI Reference # of Identical 1, 3 (>=CF-iR crawl- space, Duct Cooling Load Cooling Capacity pump) and Model Numb( Number2 Systems value)4 _ etc.) R -value (kBtu/hr) (kBtu/hr) Split " . american standard 1 16 SEER A/C140W.4a7a5061e1000aa _ _ 4586904 jq 1 ,13_EERrK NAttie'* irR ,4.2 .,053VV, 55 kBtu r. "rtr ° x V-" # i '31'' VT 11� :'"�.; 4. `-. •AgrF .iii... .�r. •- . .�y....: yri ^'st iy�' rhtl t ' a 1. If project is new construction, see Footnotes to Standards Table 151-B and Table 151-C for duct ceiling alternative compliance. S' 2. ARI Reference Number can be found by entering the equipment model number at http://www.aridirectory.org/ari/ac:php# , 3. Listed efficiency on this page must be greater than or equal ( ? ) to the value shown on the CF -1R form. - 4. When CF -IR is reference it is also applicable to the CF -1R, CF -IR -AA or CF -1R -ALT ALL BOXES MUST BE CHECKED TO BE A VALID FORM - R §110-§113: HVAC equipment is certified by the California Energy Commission. Pj.§150(h): Heating and/or cooling loads calculated in accordance with ASHRAE; SMACNA, or ACCA.' E §150(i): Setback Thermostat on all applicable heating and/or cooling systems meet the requirements of §112(c). 1::.• ` 21 §150(j)2: Pipe insulation fortcooling system refrigerant suction, chilled water and brine lines meets minimum requirements of Table 150-B and includes a vapor retardant or is enclosed entirely in, . = conditioned space. ,' • • 4's.: i• •. •.. � e - • - • F' `' ` •. • • r •0.N * � • - 1' ' . . • r Reg: 211-A0050306A-M0400001A-0000, Registration Date/Time: 2011/10/05.18:59:46 'HERS Provider: Ca10ERTS, Inc. �2008,Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6111-MECH-09 >pace Conditioning Systems, Ducts and Fans (Page 2 of 2; Site Address: Enforcement Agency: Permit Number: 48-609 Vista Tierra, Ca Quinta CA 92253 (System 1) 1 City of La Quinta 11-1070 Ducts and Fans §150(m): Duct and Fans 17-11. All air -distribution system ducts and plenums installed, sealed and insulated to meet the requirements of CMC Sections 601, 602, 603, 604, 605 and Standard 6-5; supply -air and'return-air ducts and plenums are insulated to a minimum installed level of R-4.2 or enclosed entirely in conditioned space. Openings shall be sealed with mastic, tape or other duct -closure system that meets the applicable requirements of UL 181, UL 181A, or UL 181B or aerosol sealant that meets the requirements of UL 723. If mastic or tape is used to seal openings greater than 1/4 inch, the combination of mastic and either mesh or tape shall be used; and 0 1. Building cavities, support platforms for air handlers, and plenums defined or constructed with materials other than sealed sheet metal, duct board or flexible duct shall not be used for conveying conditioned air. Building cavities and support platforms may contain ducts. Ducts installed in cavities and support platforms shall not be compressed to cause reductions in the cross-sectional area of the 'ducts. Y 1:1 2D. Joints and seams of duct systems and their components shall not be sealed with cloth back. rubber adhesive duct tapes unless such tape is used in combination with mastic and draw bands. ❑ 7. Exhaust fan systems have back draft or automatic dampers. ❑ 8. Gravity ventilating systems serving conditioned space have either automatic or readily accessible, manually operated dampers. r ❑ Protection of Insulation.}Insulation shall'be protected from damage, including that due to sunlight, moisture, equipment maintenance, and wind. Cellular foam insulation shall be protected as above or painted with a coating thatl,is water retardant and provides shielding from solar radiation that can cause 'd •egradation'of•the material}; t: El 10. Flexible ducts cannot have porous inner cores. �'`' ami �f :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 eligible under Division,3 of the Business and Professions Code to accept responsibility for construction, or an authorized , representative of the person responsible for construction (responsible person). • I certify that the installed features, materials, components, or manufactured devices identified on this certificate (the installation) conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the enforcement agency. • I reviewed a copy of the Certificate of Compliance (CF -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 occuoancv. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) CERTIFIED COMFORT SYSTEMS INC , Responsible Person's Name: Responsible Person's Signature: Mark Hyde Mark Hyde - CSLB License: Date Signed: Position With'Company (Title): 906115 ! 9/28/2011 Reg: 211-A0050306A-M0400001A-0000 Registration'Date/Time: 2011/10/05 18:59:46 2008 Residential Compliance Forms ` HERS Provider: CalCERTS, Inc. August 2009 - .l � I . • Reg: 211-A0050306A-M0400001A-0000 Registration'Date/Time: 2011/10/05 18:59:46 2008 Residential Compliance Forms ` HERS Provider: CalCERTS, Inc. August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS Duct Leakage Test — Existing Duct System (Page i of 2) Site Address: Enforcement Agency: Permit Number: 48-609 Vista Tierra, La.Quinta CA 92253 (System 1) 1 City of La Quinta 11-1070 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. 1. Measured leakage less than 15% of fan flow ❑ 2. Measured leakage to outside less than 10% of Fan Flow L, t F1 3. Reduce leakage by 60% and conduct smoke and fix all leaks 4 4. Fix all accessible leaks using oke and HERS rater verify - Note:�(One of Options 1, 2 or 3 mus be attempted before utilizing Option 4.) Determine nominal Fan Flow using one of.the following three calculationrmethods. [� Cooling+system method: Size of condenser �n Tons 5 �x 400 2000CFM ► q , method:�21J x'* Output Capacityrin -Thousands of,Bt'u/hr�= � CFM i � ------ ✓ G Heatin,g� �s"ystem " ✓ El Measured systemfairflow using RA3 3.airflow,testpprocedures: }CFM INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS Duct Leakage Test — Existing Duct System (Page i of 2) Site Address: Enforcement Agency: Permit Number: 48-609 Vista Tierra, La.Quinta CA 92253 (System 1) 1 City of La Quinta 11-1070 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. 1. Measured leakage less than 15% of fan flow ❑ 2. Measured leakage to outside less than 10% of Fan Flow F1 3. Reduce leakage by 60% and conduct smoke and fix all leaks 4 4. Fix all accessible leaks using oke and HERS rater verify - Note:�(One of Options 1, 2 or 3 mus be attempted before utilizing Option 4.) Determine nominal Fan Flow using one of.the following three calculationrmethods. [� Cooling+system method: Size of condenser �n Tons 5 �x 400 2000CFM ► q , method:�21J x'* Output Capacityrin -Thousands of,Bt'u/hr�= � CFM i � ------ ✓ G Heatin,g� �s"ystem " ✓ El Measured systemfairflow using RA3 3.airflow,testpprocedures: }CFM _` CI€ a„�:'�+;;p�' t ' _� �' LL tif'. x"2000 x300' SK 1 jOption1,1zused'.fhen Allowed leakage Fan Airfl w - x 015•. Cl V �- r• g Actual Leakage =' 198 CFM's. --11-''.. ­ .. . Pass if Actual Leakage is less than Allowed leakage Pass Fail - Option 2 used then:: 2 Allowed leakage = Fan Airflow " x 0.10 = _ CFM Actual Leakage to outside =_ CFM ', \ Pass if Actual leakage to outside is less than Allowed leakage Ci Pass r-1 Fail Option 3 used then: v " Initial leakage prior to start of work = _ CFM Final leakage after sealing all accessible leaks using smoke test = _ CFM 3 Initial leakage _ - Final leakage _ = Leakage reduction CFM ((Leakage reduction _ / Initial leakage _) x 100% _ %o Reduction Pass if % Reduction > 60% ri Pass r 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 „rj Pass ; Fail Reg: 211-A0050306A-M2100001A-0000 Registration Date/Time: 2011/10/05 18:57:40 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 , 4 r ' Reg: 211-A0050306A-M2100001A-0000 Registration Date/Time: 2011/10/05 18:57:40 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 , 4 Reg: 211-A0050306A-M2100001A-0000 Registration Date/Time: 2011/10/05 18:57:40 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 NSTALLATION CERTIFICATE CF-6R-MECH-2I-HER'. luct Leakage Test — Existing Duct System (Page 2 of 2 >ite Address: I Enforcement AgenPermit Number: cy: I8-609 Vista Tierra, La Quinta CA 92253 (System 1) City of La Quinta 11-1070 © Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, sliall 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 t6 the closed position during duct leakage testing. f D All supply, and*return register boots -must be sealed too the drywall if,smoke�test is.utilized.for�compliance , — applies tom ct leakage compliance option 3 (leakageireduction byj60%.)'hand option 4.(fz all accessible leaks) described above: �' .d�, ,.y f,r(f , • p" xi---�- ��;, Aum o�Ileufof,ducts.-, � • New dulct iAwl nstallations cannot utilize building ca vi ti e s as plenums or,platfrm;returns iy_rY 77 • Mastic andxdrawibands must,be,usedJmcombination�withlcloth backed,xubberAclhesive duct tape�to seal leaks at all" new ductFeonneCtlOf1S,"-'*^�ya'�r��"y��3Y»x;" • www .•. ".. F 4 � , , ,. f 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 o the Buslness and Professions Code to accept responsibility for construction, or an authorized ' representative of the person responsible for construction (responsible person). e I certify that the installed features; materials, components, or manufactured devices identified on this certificate (the installation) f conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the. enforcement agency. e 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 '4 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) .r CERTIFIED COMFORT SYSTEMS INC T Responsible Person's Name: Responsible Person's Signature: Mark Hyde Mark Hyde CSLB License: 906115 Date Signed: 9/29/2011 ,- )• Position With Company (Title): Is this installation monitored by a Third Party Quality +". Name of TPQCP (if applicable): C t I P (TPQCP)7 El Yes C N on ro Program es o - Reg: 211-A0050306A-M2100001A-0000 Registration Date/Time: 2011/10/05 18:57:40 HERS Providdr: CalCERTS, Inca 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: 48-609 Vista Tierra, La Quinta CA 92253 1 City of La Quinta 11-1070 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 i System Location or Area Served Whole House 1 p Yes I] No 5/16 inch (8 mm) access hole upstream of evaporative coil in the return plenum and labeled according to Figure in Section RA3.2.2.2.2. 2' p Yes ❑ No 5/16 inch (8 mm) access hole downstream of evaporative coil in the supply plenum and labeled according to Figure in Section RA3.2.2.2.2. Yes to 1 and 2 is a pass. �. Enter Pass or Faill ✓ R Pass ✓ ❑ Fail STMS' -Sensor on -the EvaporatonCoil_:__ System Narne,or Identification/Tag's •_, `,e System ib -° _,._ ", r ; , r, i:, � 3 f:t=" ❑Yes RINO The sensor is factory" installed, or fieldiinstalled according to manufacturer's specifications, or is(mstalled by methods%specifications approved by the Executive`— r Yes ❑ No specifications, or is installed by methods/specifications approved by the Executive Director. ... _ 4 /,!42, The sensor wire is terminated with a, standard, mini plug suitable for connection to a' di ." ���' .P d The plug to installs, i ❑YesNo The sensor wire is terminated with a standard mini plug suitable for connection to a 9. 9.. 9z 4 ital`thermometer , sensor mini is. accessible ,the technician; ❑ Yes ❑ No digital thermometer. The sensor mini plug is accessible to the installing technician and the,HERS!rater,wifhout changing the airflow through the condenser coil . 5 ❑Yes -1 No IThe sensor measures the saturation temperature of the coil within 1.3 degrees F Yes to 3,.4i -and -5 -is a1pass. Enter N/A if STMS are not V 2N/A ✓ ❑ Pass ✓ Fail applicable. Otherwise enter Pass or Fail ✓ ❑ Pass ✓ ❑ Fail applicable. Otherwise enter Pass or Fail STMS -Sensor on the Condenser Coil System Name or Identification/Tag System 1 , The sensor is factory installed, or field installed according to manufacturer's 6 r Yes ❑ No specifications, or is installed by methods/specifications approved by the Executive Director. The sensor wire is terminated with a standard mini plug suitable for connection to a 7 ❑ Yes ❑ No digital thermometer. The sensor mini plug is accessible to the installing technician and the HERS rater without changing the airflow through the condenser coil 8❑Yes I p 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 7 ✓ 0 N/A ✓ ❑ Pass ✓ ❑ Fail applicable. Otherwise enter Pass or Fail Reg: 211-A0050306A-M2500001A-0000 Registration Date/Time: 2011/10/05 18:57:04 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 i INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5) Site Address: Enforcement Agency: Permit Number: 48-609 Vista Tierra, La Quinta CA 92253 City of La Quinta 11-1070 Standard Charge Measurement Procedure (for use if outdoor air dry-bulb is above 55°F) Procedures for determining Refrigerant Charge using the Standard Charge Measurement Procedure are available in Reference Residential Appendix RA3.2. As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional form(s) for any additional systems in the dwelling as applicable. • The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure. • The system must meet minimum airflow requirements as prerequisite for a valid refrigerant charge test. • If outdoor air dry-bulb is 55°F or below, the installer must use the Alternate Charge Measurement Procedure. Space Conditioning Systems System Name or Identification/Tag System 1 _- 9/29/2011 System Location or Area Served Whole House yy1���{1y j 9/29/,2011 Outdoor Unit Serial # 110431ta2f Outdoor Unit Make american standard Outdoor Unit Model 4a7a5061e1000aa Nominal Cooling Capacity Btu/hr F 60000 Date of Verification 9/29/2011 Calibration of Diagnostic Instruments r Date of Refrigerant Gauge Calibration L �p _- 9/29/2011 (must be re -calibrated monthly) _1 .1N' Ir Date of Thermocouple Calibration yy1���{1y j 9/29/,2011 S f Aim f v (must be re -calibrated monthly) Measured Temperaturesr(,F) 7 /, J J ; f '.; . d . , 11%,-., & System Name or Idpeyntyificaaittiyon/Tyag;. t �p _- �ySysytem; yy1���{1y Supply (eJaporatoe leaving'),air dry-bulb temperature (Tsupply, db) Return (evaporator -entering) air dry-bulb temperature (Treturn, db) Return (evaporator entering) air wet -bulb temperature (Treturn, wb) Evaporator saturation temperature 44 (Tevaporator, sat) Condensor saturation temperature 105 (Tcondensor, sat) Suction line temperature (Tsuction) 64 Liquid Line Temperature (Tliquid) 96 Condenser (entering) air dry-bulb 97 temperature (T condenser, db) 10� Reg: 211-A0050306A-M2500001A-0000 Registration Date/Time: 2011/10/05 18:57:04 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5) Site. Address: Enforcement Agency: Permit Number: 48-609 Vista Tierra, La Quinta CA 92253 1 City of La Quint a 11-1070 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 1c f INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5) Site. Address: Enforcement Agency: Permit Number: 48-609 Vista Tierra, La Quinta CA 92253 1 City of La Quint a 11-1070 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, 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 -3°F and +3°F or, upon. remeasurement, if between -3°F and . �. -100°F S ' Enter Pass or Fail . Note: Temperature Split Method Calculation is not necessary if actual Cooling Coil Airflow is verified using one of the airflow measurement procedures specified in Reference Residential Appendix RA3.3. If actual cooling coil airflow is measured, the value must be equal to or greater than the Calculated Minimum Airflow Requirement in the table below. Calculated Minimum Airflow Requirement (CFM) = Nominal Cooling Capacity (ton) X 300 (cfm/ton) - System �Na - d' ntttii iic tion/TagA};' s� m 1 4�'. ^ ' r • f, y Calculated'Mi,pnimum AirfloWReyquiiremc e)fint (CFM) 150L0:' , ° j A Measured�Airflow u sing RA�3 procedures (CFM).`/��(� ,,,.. 5�r:4 Passes if measured airflow is greater -than or— equal to the calculated minimum airflow requirement:-"—. PASS 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 R �. ,r, Enter Pass or Fail _ 2 Reg: 211-A0050306A-M2500001A-0000 ,Registration-Date/Time: 2011/10/05 18:57:04 HERS Provider: CalCERTS, Inc.' 2008 Residential Compliance Forms 'August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5) Site Address: Enforcement Agency: Permit Number: 48-609 Vista Tierra, La Quinta'CA 92253 City of La Quinta1 11-1070 Subcooling Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag 'System 1 b Calculate: Actual Subcooling = 9.0 r , Tcondenser, sat - Tliquid s a Target Subcooling specified by manufacturer" 8 Calculate difference: 1 ' Actual Subcooling - Target Subcooling =' System passes if difference is between =1Ph+t PASS, �;• e ,y. fir. -3°F and +3°F PASS r �(,; .,rx�*.?`"`,, �•- ._•. Enter Pass or Fail Metering Device Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag System 1 b Calculate: Actual Superheat = 20.0 Tsuction - Tevaporator, s a Enter- allowable superheat range from manufacturer's specifications (or use range : between 4°F and 25°F if manufacturer's - 4-25 ' specification is not available) _ System passes;if a(ftu0superheat is-withinfthe-f allowable superheat range�'�z =1Ph+t PASS, �;• e ,y. fir. ►: d(�. ,Enter Pass or,Fail,4. r �(,; .,rx�*.?`"`,, �•- ._•. �r ' , ' .• ' • .. • : � « qhs 4 _. .. R +: • . Reg: 211-A0050306A-M2500001A-0000. Registration Date/Time: 2011/10/05 18:57:04 HERS Provider: CalCERTS, Inc. •2008 Residential Compliance Forms August 2009 b s a �r ' , ' .• ' • .. • : � « qhs 4 _. .. R +: • . Reg: 211-A0050306A-M2500001A-0000. Registration Date/Time: 2011/10/05 18:57:04 HERS Provider: CalCERTS, Inc. •2008 Residential Compliance Forms August 2009 Y INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification Standard Measurement Procedure (Page 5 of 5) Site Address: Enforcement Agency: Permit Number: 48-609 Vista Tierra, La Quinta CA 92253 City of La Quinta 11-1070 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: J Position With Company (Title): System meets all refrigerant charge and airflow 9/29/2011 Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): requirements. PASS Enter Pass or Fail ' . 1 4 a _ I ' ��4�1 �.p ,{.eR �{�. h� •^ �' �r'-,a`�•�M:� 60, .. .. ,�.. , y� t �, w�'z ='}'t . •'I.X.._ . -s^ .•.,mac ` � -n t .�_ t DECLARATION+ STATEMENT . I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. . I am eligible under Division 3 of.the Business and Professions Code to accept responsibility for construction, or an authorized representative of the person responsible for construction (responsible person). . I certify that the installed features, rhaterials, 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 r 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) CERTIFIED COMFORT SYSTEMS INC p Responsible Person's Name: Responsible Person's Signature: F e Reg: 211-A0050306A-M2500001A-0000 Registration Date/Time: 2011/10/05 18:57:04 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009 Mark Hyde ( Mork Hyde CSLB License: Date Signed: J Position With Company (Title): 906115 9/29/2011 Is this installation monitored by a Third Party Quality Name of TPQCP (if applicable): Control Program (TPQCP)? ❑ Yes ❑ No e Reg: 211-A0050306A-M2500001A-0000 Registration Date/Time: 2011/10/05 18:57:04 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms August 2009