Loading...
12-0757 (MECH)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Application Number:12 X000"0-0757- Owner: Property Address: 149951 A ENIDA VISTA BONITA BARTIS DAVID G APN: 773-340-074-137 �-14496 - - 49951 AVENIDA VISTA BONITA Application description: ` MECHANICAL LA QUINTA, CA 92253 Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 14888 Contractor: Applicant: Architect or Engineer: GENERAL AIR CONDITIONING 31170 RESERVE DRIVE VOICE (760) 777-7012 FAX (760)'777-7011 INSPECTIONS (760) 777-7153 Date: 7/10/12 f. D THOUSAND PALMS, CA 92276 ' JUL Q 2012 (760) 343-7488 ('%" ' )) r!` '\Lic*. No.: 686310 !' CITY OF LA QUINTA FINANCE DEPT. ------------------------------------------------------------------------------------------------- LICENSE CONTRACTOR'S DECLARATION - WORKER'S COMPENSATION DECLARATION , • - I hereby affirm under penalty of perjury that I am li ns6d 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.P essionals 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 , License Class: C20 License No.: 686310 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is �� issued. Yater ntractor:t 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 s - NER-BUILDER DECLARATION insurance carrier and policy number are: - o I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier ZENITH INS - CO Policy Number Z071741501. - 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 wor or 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 becomes ject 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 subVlomthe�wo�rtkers' compensation provisions of SectionLicense Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or - 3700 of the Labor Code, I shall forthwy wih 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 1$500).: - ate: <O 1 pplicant: • (_ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and 10 the structure is not intended or offered for sale 'Sec. 7044, Business and Professions Code: The WARNING: FAILURE TO SECURE WORKER PENSATION 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- , ( ) 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, (—I 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 omissionrelatedto the work being " -" - - - - - - - performed under or following issuance of this permit. Date: Owner: 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,icesion of work for 180 days will subject CONSTRUCTION LENDING AGENCY permit to cancellation.I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that I have read this application and state that the above infis correct. I agree to comply with allwork for which this permit is issued (Sec. 3097, Civ. C.)•. city and county ordinances and state laws relating to building constrnd hereby authorize representativesof t is county to enter upon the above-mentioned property for inspeposes ` Lender's Name: /1 Date: 7 O Signature (Applicant or Agent): Lender's Address: rl LQPER.MIT , - Application Number . . . . . 12-00000757 Permit MECHANICAL Additional desc . j Permit Fee 40.50• Plan Check Fee 10.13 Issue Date . . . . Valuation . . . . 0 `. Expiration Date 1/06/13 Qty 'Unit Charge Per Extension t BASE FEE 15.00 1.00 9.0000 EA MECH FURNACE <=100K .9.00 1.00 16.5000 EA MECH B/C >3715HP/>100K-500KBTU 16.50 Special Notes and Comments HVAC CHANGE -OUT: -4 TON SPLIT SYSTEM -OUTDOOR UNIT AT GROUND LEVEL. 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-1R-ALT-HVAC Climate Zones 10 - 15 Site Address: Enforcement Agency: Date: Permit #: 49951 AVENIDA VISTA BONITA La Quinta, CA 92253 City of La Quinta Jul 9, 2012 Equipment Types List Minimum Efficiency2 Duct insulation requirement Conditioned Floor Area Thermostat ❑ Package Unit ® Furnace ® Indoor Coil ® AFUE o ® SEER 13.0 COP ❑ HSPF ❑ R 6 (CZ 10-13) Served by system If of already present, must be ® Condensing Unit ❑ EER ❑ Resistance ❑ R 8 (CZ 14-15) 1591 sf 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-IR and CF-6111 shall also be on site for final inspection. ® 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-411 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 Pei; Paskaged Units-1 Q---et Exempted from duct leakage testing<lf: ❑ 1. Duct system was documented to have been previously sealed and confirmed through HERS verification, or [12. Duct systems with less than 40 linear feet in unconditioned space, or '❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos ❑ 4. Th",,,ytem will not be Ducted (ie DucGless¢Min� Sp t Systemjl-(,A!s,p ExeTpt f orr!�Refr!gera�nt-Charge) ❑ 2. NewHVAC System RequieciiFolrms . Cut m�or Changeout with ducts CF 6)i formsMECH-04 MECH-2 'HERS and (for split systems) MECH' 22 HERS End ' new (all new ducts Ing tinct all-new I f L, MECH,25 HERS CFS MECH-.20,nd `(for s tit systems)MECH;=22; and MECH 25 equipment)_ ,oR�"rms� P Y akage <6 percent, RC;CCA> 350 CFM/ton; FWD;rTMAH,#STNS, andgelther iiSPP or-PSPP. For Packaged Units. Dint leakage <6 percent ❑ 3 New�Ducts-with/or without,'.,.Required Forms: Replacement rr . Includes replacing or installing all.new ducting and/or outdoor condensing unit CF-611 forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS and/or indoor coil and/or fdrnace::No or some CF-411 forms: MECH-20 and (for split systems) MECH-25 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 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: Danielle Garcia Signature: banielle Garcia Company: HARRISON ENTERPRISES INC Date: Jul 9, 2012 Address: 31-170 RESERVE DRIVE STE A License: 686310 City/State/Zip: THOUSAND PALMS / CA / 92276 Phone: (760) 343-7488 Reg: 212-A0036239A-00000000-0000 Registration Date/Time: 2012/07/09 16:15:51 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms July 2010 Bin # Crtiy of ..La Quinta Building 8r Safety Division P.O. Box 1504,78-495 Calle Tampico 1a.Quinta, CA 92253.:(760) 7777012 Building Permit Application and Tracking Sheet Permit # 5� Proj ect Add.mss: -1 rJ I ���` Ol 15�q nI Owner's Name:. A. P. Number. Address: mp Legal Description: City, ST, Zip: Contractor: c r` F Telephone: • 3 Address: 3 _ 17 b ��-v ��� . Project Description: �,h - D V1 City, ST, Zip: 4 2 Z `) 4 S S m- Q n Telephone: ` 1 p � 4 3 - 748% ;gip � :�. r City Lie'. #; iovrQ State Lic. # : Arch., Engn, Designer Address: City., ST, Zip: Telephone: State Lie. #: f ' ,. »- Name of Contact Person:Sq. Construction Type: Occupancy: Project type (circle one): New Add'e Alter Repair Demo Ft.: I # Stories: #Univ: Telephone # of Contact Person: Estimated Value of Project: wig, 0 APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cales. Reviewed, ready for corrections Plan Check Deposit. . Tins Calcs. Called Contact Person Plan Check Balance Title 24 Calcs. Plans picked up Constructio a Hood plain plan Plans resubmitted.. Mechanical Grading plan 2fd Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resabmttted Grading IN ROUSE:- '"' Review, ready for correetionsAssue Developer inpact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue 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: 49951 AVENIDA VISTA BONITA, La Quinta CA 92253 Enforcement Agency: Permit Number: (System 1) City of La Quinta 12-757 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. 131. 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 - smoke ❑ 4:'Fix all accessible leaks using and HERS rater verify Note: (One oQOptions_l, 2, or 3 must-be-attempted�before:utilizing Option 4:)_ ., Determinevnominal Finn Flow using `one ofsthe following three calculation methods � f` ✓ ❑ Cooling system method: Size df condenser in Tons x 400 = CFM ' " •. �,,. ✓ ❑ Heating'system method: 21.7.x Output Ca pauty in Thousands of Btu/hr �Si - � C i i� h'P ✓❑ Measured,system airflow using 3.3 airflowEtest procedure _CFM, P Otion'i used then: y., • - . K�.�, 1 Allowed leakage = Fan Flow -x 0..5F _CFM .f- �' Acctual; Leakage =F_CFM . - " N Pass if Leakage Actual is less than Allowed p Pass C3 Fail Option 2 used then: 2 Allowed leakage = Fan Flow x 0.10 = _ CFM Actual Leakage to outside,.=' CFM N Pass if Leakage Actual is less than Allowed Pass Fail Option 3 used then: Initial leakage prior to start of work = _ CFM Final leakage after sealing all accessible leaks using smoke test = _ CFM , 3 Initial leakage _ - Final leakage _ = Leakage reduction CFM " ((Leakage reduction _/ Initial leakage ) x 100% _ % Reduction Pass if % Reduction >= 60% Pass ❑ Fail, Option 4 used then: 4 All accessible leaks repaired using smoke. HERS rater must verify (No sampling). No smoke allowed to leak from system. Including ducts, plenums, air handler and door panel. Pass if all accessible leaks have been repaired using smoke ❑ Pass ❑ Fail #r - K s Reg:-212-A0036239A-M2100001A-M21A Registration Date/Time: 2012/08/28 20:29':33 HERS Provider: Ca10ERTS, Inc.," 2008 -Residential Compliance Forms; March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-21 Duct Leakage Test - Existing Duct System (Page 2 of 2) Site Address: 49951 AVENIDA VISTA BONITA La Quinta CA 92253 _ Enforcement Agency: Permit Number: (System 1) City of La Quinta 12-7-57 i r 0 Outside air (OA) ducts for central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off ` during duct lea kage,#esting.,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 ay•be configured to.the closed positionduring duct leakage testing. + ❑All supply and return;:register:boots must be seal�ed`to the`drywall;if,smoke testis utilized far/compliance , - applies"to'duct leakage compliance option 3 (leakage reduction by`60%) and option'4. (fix C.11 accessible leaks described above• 0 New duct installbtions,cannot utilize building'cavities asfplenumsTor,platform rete ns'in lied ofFducts. ' ' �.""'."--,�`�', g•. ' u 0 Mastic and draw bands must'be used�in combination witt'cloth backed.rub6ee ;adhesive dua tape to seal `' I. leaks at all new.duct connections. , DECLARATION STATEMENT . I certify under penalty of perjury, under the laws of the State of Califomia, 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). , t.• t . The installed feature, material, component, or manufactured device requiring HERS verification that is identified on this certificate (the a ' 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. Y. . ,The information reported on applicable sections of the Installation Certificate(s) (CF -611), signed and submitted by tie 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 -61111)' Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) HARRISON ENTERPRISES INC Responsible Person's Name: CSLB License: Danielle Garcia 686310' HERS Provider Data Registry Information Sample Group # (if applicable): 317872 i 0 not-tested/verified dwelling in la s r 0 Outside air (OA) ducts for central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off ` during duct lea kage,#esting.,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 ay•be configured to.the closed positionduring duct leakage testing. + ❑All supply and return;:register:boots must be seal�ed`to the`drywall;if,smoke testis utilized far/compliance , - applies"to'duct leakage compliance option 3 (leakage reduction by`60%) and option'4. (fix C.11 accessible leaks described above• 0 New duct installbtions,cannot utilize building'cavities asfplenumsTor,platform rete ns'in lied ofFducts. ' ' �.""'."--,�`�', g•. ' u 0 Mastic and draw bands must'be used�in combination witt'cloth backed.rub6ee ;adhesive dua tape to seal `' I. leaks at all new.duct connections. , DECLARATION STATEMENT . I certify under penalty of perjury, under the laws of the State of Califomia, 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). , t.• t . The installed feature, material, component, or manufactured device requiring HERS verification that is identified on this certificate (the a ' 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. Y. . ,The information reported on applicable sections of the Installation Certificate(s) (CF -611), signed and submitted by tie 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 -61111)' Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) HARRISON ENTERPRISES INC Responsible Person's Name: CSLB License: Danielle Garcia 686310' HERS Provider Data Registry Information Sample Group # (if applicable): 317872 Q tested/verified dwelling 0 not-tested/verified dwelling in la HERS sample group HERS Rater Information CaICERTS Certificate # CCl-1798671647 HERS Rater Company Name: The Energuy CA LLC ` Responsible Rater's Name: Responsible Rater's Signature: Ezequiel Moreno Ezequiel Moreno , Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 8/27/2012' CC2005795 Reg: 212-A0036239A-M2100001A-M21A Registration'Date/Time: 2012/08/28 20:29:33 ,HERS F_ovider: CalCERTS,,Inc. ' eF. 2008• Residential -Compliance Forms March 2010 :-.. Reg: 212-A0036239A-M2100001A-M21A Registration'Date/Time: 2012/08/28 20:29:33 ,HERS F_ovider: CalCERTS,,Inc. ' eF. 2008• Residential -Compliance Forms March 2010 A 1, 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: 49951 AVENIDA VISTA BONITA, La Quinta CA 92253 City of La Quinta 12-757 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 [3 Yes [3 No, h, 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 [3 Yes ❑ No .11 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 to4-.and_.2 is a pass.. I t Enter Pass or Fail ✓ ❑ Pass ✓ ❑ Fail STMS °._Sensor-ontthe,Evaporator Coil:... _Www, System Name°or Identification/Tagg j=`. `,rf" 'j/ 1 7—) - ;A sir 1 t - t (: I V T'<' Yes S , The sensor is factory installed- or field:installed according to'manufaeturer's- 3 Q ❑ No : F - specifications, or is'�installed by methods/specificaf ions approved by=the Executive= .. .41"j I Director: 4 f , frCi _ No fThe sensor wipes terminated.with a standard mini plug suitable for connection,to a ❑ Yes ❑Yes, ., p digital them•iometer. The-sens6r,mni plug is accessible to'th'e.installingztechrnciari and the HERS'rater.,without changing the airflow through the condenser coil 5/ ❑ Yeses ❑ No When attached to a digital thermometer, the sensor provides an indication of the ❑Yes -- -s 4 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 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 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 ® N/A ✓ ❑ Pass✓ ❑ Fail applicable. Otherwise enter Pass or Fail Reg: 212-A0036239A-M2500001A-M25A 'Registration Date/Time: 2012/08/28 20:31:58 HERS Provider: Ca10ERTS,'Inc' 2008 Residential Compliance Forms March'2010 ,3 System i � r 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 Refe ence Residential.• *w Appendix RA3.2.•As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an aciditional 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. a • If outdoor air dry-bulb is 55°F or below, the installer must use the Alternate Charge Measurement Procedure. 1 Space Conditioning Systems Y System Name or Identification/Tag System i (must be re -calibrated monthly) Date of ThermP d ocou le Calibration ,.,. Y � '� System Location or Area Served Whole House r = Outdoor Unit Serial # ' • t ` Outdoor Unit Make , Outdoor Unit Model . t• Nominal Cooling Capacity Btu/he.' 1 Date of Verification r Calibration'of Diagnostic Instruments r Date of Refrigerant Gauge Calibration System,iDam- (must be re -calibrated monthly) Date of ThermP d ocou le Calibration ,.,. Y � '� (must be re-cahbzi A f-� ated monthly) i - r = 1 t Return -(evaporator. -entering) air dry-bulb` temperature (Treturn, db� Date of Refrigerant Gauge Calibration System,iDam- (must be re -calibrated monthly) Date of ThermP d ocou le Calibration ,.,. Y � '� (must be re-cahbzi A f-� ated monthly) of �' � _, �` �,.. '�+ ; •:� k .:��..."" r� C•�-� •:k...m,.� `_ Measured Temperaturee-QF) `%j jf,'j W 04' °� , System Name or Idyentification/yyTag .+- System,iDam- [ Supply'(evaporatbr temperature (TsuPP supply, . Ddb) 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: 212-A0036239A-M2500001A-M25A .Registration Date/Time: 2012/08/28 20:31:58 HERS Pr -wider: Ca10ERTS,'Inc. a 2008 . Residential Compliance Forms - ,a March 2010. INSTALLATION CERTIFICATE CF-4R-MECH-25 t Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5) Site Address: Enforcement Agency: Permit Number: 49951 AVENIDA VISTA BONITA, La Quinta CA 92253 1 City of La Quinta 12-757 = 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 Identificatior%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 j 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 Mini"mum Airflow Requirement (CFM) = Nominal Cooling Capacity (ton) X 300 (cfm/ton) System. Name dr--lde tification/Tag- . _ - t14 Calculated Minimum Airflow!16-quirement (CFM)r11 { d Measured Airflow using RA3 3 procedurges (CFM) .--•-" d � , .. , ip ,.,: i T Passes'if measured airflow is,greaterr than or�equal- ��-� =.• � to the calculated minimum airflow requirement. •': .: >3 '" 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 j �r Enter Pass or Fail Reg: 212-A0036239A-M2500001A-M25A Registration Date/Time: 2012/08/28 20:31:58 HERS Provider: CalCERTS, Inc. March 2010 2008 Residential,Compliance Forms .. i .. Subcooling Charge Method Calculations for Refrigerant Charge Verification. This procedure is recuired to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag. - :r Calculate: Actual Subcooling = Tcondenser, sat - Tliquidf. 4' i , Target Subcooling specified.by manufacturer ' r; s Calculate difference: manufacturer's specifications (or use range Actual Subcooling - Target Subcooling-= s between 3°F and 26°F if manufacturer's System passes if difference is between specification isnot available),.., -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 .. ,;U :r r' it Calculate: Actual Superheat_,= 4' • y r; } Enter°allowable superheat. range from manufacturer's specifications (or use range s between 3°F and 26°F if manufacturer's specification isnot available),.., System passes if actual superheat KWithindfhe— allowable superheat range` Metering Device Calculations for Refrigerant Charge Verification. This procedure is required to be used for • thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag .. ,;U r' it Calculate: Actual Superheat_,= Tsuction - Tevaporator, sat ^' Enter°allowable superheat. range from manufacturer's specifications (or use range s between 3°F and 26°F if manufacturer's specification isnot available),.., System passes if actual superheat KWithindfhe— allowable superheat range` Enter Pass or,Fail �..''� 177 (• _ `' - `,. ?� :.?rte r = 1.' ' sTM. ,. : _ '' ' , - {l y. � `'! t n• - .. _ 4„ -tri - `�`". c, ti - ` ♦'• _, . t ! 7 ' i .] .X.+ •. p w '� LT'1 .. � ,/ � f .. �. f , � .{ • 1. , . , "� L ! + J �A . ,• , , . F ., w' - -• 9.'-51 ���+ - .. r !.� y s a1 `' '+ •j .e: 1. } ' ' . S 'tom. . • . - .' - tea 16 je. + i. eY' ]_ , is'!S. .r . _ r _ -' t t- � •, � .. r 4 1� .. •. ;,,r { sI ^`V !] ,. ,,� f� • Y- � - �+"+ cam- a �, - �t �� .d 4Reg:%-212-A0036239A-M2500001A-M25A..Registration Date/Time:,2012/08/28 20:31:58 HERS-P-ovider: Ca10ERTS,' Inc. a 2008 Residential Compliance Forms March, 2010 • C ..syr .�� � ,•. •� ' - 1' •'�'� •.. a. •{' - }' � !' Wi ^F, � �_ 1 • +♦- - _ 1 1 , INSTALLATION CERTIFICATE CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5) Site Address: Enforcement Agency: Permit Number: 49951 AVENIDA VISTA BONITA, La Quinta CA 92253 City of La Quinta 12-757 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 actionE were taken, all applicable verification criteria must be re -measured and/or recalculated. System Name or Identification/Tag System 1 686310 HERS Provider Data Registry Information ' Sample Group # (if applicable): 317872 System meets all refrigerant charge and airflow © not-tested/verified dwelling in, la HERS sample group _ requirements. HERS Rater Company Name: _ The Energuy CA LLC M - Responsible Rater's Name: - Responsible Rater's Signature: Enter Pass or Fail Ezequiel Moreno Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 8/27/2012 CC2005795 ' Jff v, •,' '. Xr f A*"R'.G � � •4T t Y '� �0.,�':' .w�eM�.•. p•i ' T` fi.. L�,�� `4 ..,.trF •. (fJ DECLARATION STATEMENT` • I certify under penalty of perjury, under the laws of the State of California, the Information provided on this form is :rue 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 r installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified on the Certificate(s) of Compliance (CF -SR) approved by the local enforcement agency. • The information reported on applicable sections of the Installation Certificate(s) (CF -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) a.:)proved by the .T -enforcement agency. Builder or Installer information as shown on the Installation Certificate (CF -61111) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) t HARRISON ENTERPRISES INC Responsible Person's Name: CSLB License: " Danielle Garcia 686310 HERS Provider Data Registry Information ' Sample Group # (if applicable): 317872 TO tested/verified dwelling © not-tested/verified dwelling in, la HERS sample group _ HERS Rater Information " CaICERTS Certificate # CC1-1798671647 HERS Rater Company Name: _ The Energuy CA LLC M - Responsible Rater's Name: - Responsible Rater's Signature: Ezequiel Moreno U Ezequiel Moreno Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 8/27/2012 CC2005795 ' + Reg: 212-A0036239A-M2500001A-M25A Registration Date/Time: .2012/08/28,20:31:58 HERS Provider:'Ca10ERTS,cInc. 2008 Residential Compliance Forms 4��' `• March 2010 Y r s + Reg: 212-A0036239A-M2500001A-M25A Registration Date/Time: .2012/08/28,20:31:58 HERS Provider:'Ca10ERTS,cInc. 2008 Residential Compliance Forms 4��' `• March 2010 Space Conditioning Systems Heating Equipment INSTALLATION CERTIFICATE CF-6R-MECH-04 " Space Conditioning Systems, Ducts and Fans (Page 1 of 2) Efficiency Site Address: 49951 AVE_ NIDA VISTA BONITA, La Quinta CA 92253 Enforcement Agency: Permit Number: f Equip '"Type ` (package . (System . 1) City of La Quinta 12-757 - ' Space Conditioning Systems Heating Equipment Cooling Equipment - ' compliance. . k'a ! ..11 , . . . ,> Efficiency Duct http://www.aridirectory.org/arilac.phO# - £ 3. Listed efficiency on this page must be greater than or equal ( ? ) to the value shown on the CF -1R form. Equip '"Type ` (package . - �` -] ALL BOXES MUST BE CHECKED TO BE A VALID FORM Efficiency Location ® §150(h): Heating and/or cooling loads calculated in accordance with ASHRAE, SMACNA, or ACCA. r Equip of t ; ARI # of (AFUE, (attic, n minimum requirements of Table 150-B and includes a vapor retardant or is enclosed entirely in Cooling Cooling Type CEO 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 Lennox 1 , _ `12 R 8 aI 48:: 5 Tons Furnace SL280UH90XV60C-03 4339420 1 80 AFUE Attic R-8 70 40 k8tu -"'=''e oil "'.`r,{� 'kms-.Sid-.�• 1% ''aa� ti' '8c, :,` +�'±A•"' "?�'.sw.`�':"' :zae+V� .�, .SOW Cooling Equipment - 1. If project is new construction see:: Footnotes to Standards Table 151-B and Table 151-C for duct ceiling alternative ' compliance. . k'a ! ..11 , . . . ,> Efficiency Dud http://www.aridirectory.org/arilac.phO# - £ 3. Listed efficiency on this page must be greater than or equal ( ? ) to the value shown on the CF -1R form. Equip '"Type ` (package . - �` -] ALL BOXES MUST BE CHECKED TO BE A VALID FORM (SEER and EER) 1,3 Location (attic, ® §150(h): Heating and/or cooling loads calculated in accordance with ASHRAE, SMACNA, or ACCA. r '®. §150(i): Setback Thermostat on all applicable heating and/or cooling systems meet the requirements of t ; ARI # of ® §150(j)2: Pipe insulation for cooling system refrigerant suction, chilled water and brine lines meets crawl- n minimum requirements of Table 150-B and includes a vapor retardant or is enclosed entirely in Cooling Cooling heat CEO Certified Mfr. Name Reference Identical (>=CF -1R space, Duct Load Capacity pump) :I and Model Number_ 'Number2 Systems value)4 etc.) R -value (kBtu/hr) (kBtu/hr) � X016=048-230-02 ot 'EER Afti'.' `' 2008,Residentia1 Compliance Forms 1 A/C , � 1 , _ `12 R 8 aI 48:: 5 Tons Sr -"'=''e oil "'.`r,{� 'kms-.Sid-.�• 1% ''aa� ti' '8c, :,` +�'±A•"' "?�'.sw.`�':"' :zae+V� .�, .SOW 1. If project is new construction see:: Footnotes to Standards Table 151-B and Table 151-C for duct ceiling alternative . compliance. . k'a ! ..11 , . . . ,> 1. ARI Reference Number can be`found by entering the equipment model number at •'' http://www.aridirectory.org/arilac.phO# - £ 3. Listed efficiency on this page must be greater than or equal ( ? ) to the value shown on the CF -1R form. " 4. When CF -1R is reference it is also applicable to the CF -1R, CF -1R -AA or CF -IR -ALT ALL BOXES MUST BE CHECKED TO BE A VALID FORM '- ® §110-§113: HVAC equipment is certified by the California Energy Commission., ® §150(h): Heating and/or cooling loads calculated in accordance with ASHRAE, SMACNA, or ACCA. , '®. §150(i): Setback Thermostat on all applicable heating and/or cooling systems meet the requirements of t ; - §112(c)... ® §150(j)2: Pipe insulation for cooling system refrigerant suction, chilled water and brine lines meets n minimum requirements of Table 150-B and includes a vapor retardant or is enclosed entirely in - conditioned space. -. r • •1• A • ., �t 'ice � - i - ] - - ,.. .i , r ot Reg: 212-A0036239A7M0400001A-0000" Registration Date/Time: 2012/07/18 17:07:05 HERS Provider: Ca1C_ERTS,'AInc. t. 2008,Residentia1 Compliance Forms 1 ' August' 2009 c. - , INSTALLATION CERTIFICATE CF-6R-MECH-04 Space Conditioning Systems, Ducts and Fans (Page 2 of 2) Site Address: 49951 AVENIDA VISTA BONITA La Quinta CA 92253 Enforcement Agency: Permit Number: (System 1) City of La Quinta 12-757 Ducts and Fans §150(m): Duct and Fans ' ® 1. 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 1818 or aerosol sealant that meets the requirements of UL 723. If mastic or tape is used to seal openings greater than 1/4 inch, tie combination of mastic and either mesh or tape shall be used; and ® 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. I - ® 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 dravr 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. ® Protection of Insolation. rInsulation shall be protected from damage, including that due to sunlight, moisture, equipment maintenance, and wind. Cellular foam insulation shall be protected 3s above or -Npainted`with a:=coating that is water retardant and provides shielding from solar radiation that can cause 715 r �r v + DECLARATION STATEMENT • I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is t.-ue and correct. . I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an auchorized 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 -SR) form approved by the enforcement agency that Identifies _he 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 applicals-e 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. 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: 686310 Date Signed: 7/7/2012 Position With Company (Title): Reg: 212-A0036239A-M0400001A-0000 Registration Date/Time: 2012/07/18 17:07:05 HERS Provider: CalCERTS,"Inc. 2008 Residential Compliance Forms. August 2009 • - y f Reg: 212-A0036239A-M0400001A-0000 Registration Date/Time: 2012/07/18 17:07:05 HERS Provider: CalCERTS,"Inc. 2008 Residential Compliance Forms. August 2009 ry i INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS Duct Leakage Test — Existing Duct System (Page 1 of 2) Site Address: 49951 AVENIDA VISTA BONITA, La Quinta CA 92253 Enforcement Agency: Permit Number: - (System 1) City of La Quinta 12-757 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 dwellingsto 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 cconduct ❑ 3. Reduce leakage 601$ and smoke and fix all leaks 4... Fix all accessible leaks using smoke HERS rater verify ❑ and 1P N Note:'(;One.of Options 1, 2 or 3 must be attempted before utilizing Optton 4,)y Determine nominal FamFlow using one ofythe`following three`calculationmethodsy' ' V10 Cooling method: Size of, condenser in Tonsr h'x 400` 1600 CFM V 1 Heating systemgmethod: 21.7[fx i Output Capajaty in:Thousands`of Btu/hr ==CFM ✓ ❑Measured system airflow using RA3 3 airflow,rtest procedure'CFM Option:1 used -then >_ A1lowed leakage–'FanAirflow 1600 •x 0.T5 – 240 ' CFMs 1 Actual'Leakage- 200 CFM 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 CFM , 'V7Pass if Actual leakage to outside is less than Allowed leakage 13 Pass . Fail Option 3 used then: Initial leakage prior to start of work = _ CFM Final leakage after sealing all accessible leaks using smoke test = _ CFM 3 Initial leakage _ - Final leakage _ = Leakage reduction _ CFM ((Leakage reduction _/ Initial leakage x 100% _ '% Reduction Pass if % Reduction > 600/6 ❑ Pass ❑ Fail Option 4 used then: AAll accessible leaks repaired using smoke test. HERS rater must verify (No Sampling). ' • Pass if all accessible leaks have been repaired using smoke ❑ Pass ❑ Fail s. L. - • ..� is - Reg: 212-A0036239A-M2100001A-0000- Registration Date/Time: 2012/07/18.17:07:39 HERS Provider" CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 t: INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS r Duct Leakage Test — Existing Duct System (Page 2 of 2) Site Address: 49951 AVENIDA VISTA BONITA, La Quinta CA 92253, Enforcement Agency: Permit Number: (System 1) City of La Quinta 12-757 ; INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS ; Duct Leakage Test — Existing Duct System (Page 2 of 2) Site Address: 49951 AVENIDA VISTA BONITA, La Quinta CA 92253, Enforcement Agency: Permit Number: (System 1) City of La Quinta 12-757 ; kL �® Outside air OA ducts for Central. Fan Integrated CFI ventilations stems shall not be sealed/taped off ' during duct.leakage,testing.rCFI 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 posii.ion during duct leakage testing. W ® All supply/and return register"bootsKmust beeea:leedAo the^dry�wallaf smoke test is l tilize�compliance — applies�to',duct leakage compliance option 3(leakage reduction by; 60%);and option 4 ,(fix allaccessible leaks) described above.. w r r r� - 0 New ductnst,.arllations.cannotutilize bulldin:g cavities as plenumor platform returns in lieu of ducts ® Mastic end draw bands must;be used,in combination,with cloth,backed.rubber_'adhesive duet tape to seal - leaks at all. new duct connections DECLARATION STATEMENT • I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. t ` • 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: 686310 Date Signed: 7/7/2012 Position With Company (Title): " Is this installation monitored by a Third Party Quality " Name of TPQCP (if applicable): Control Program (TPQCP)? ❑ Yes ❑ No Reg: 212=A0036239A`M2100001A-0000 Registration Date/Time:`2012/07/18 17:07:39 HERS Provider: Ca10ERTS,'Inc. 2008 Residential Compliance Forms* March -2010 , x _ a Reg: 212=A0036239A`M2100001A-0000 Registration Date/Time:`2012/07/18 17:07:39 HERS Provider: Ca10ERTS,'Inc. 2008 Residential Compliance Forms* March -2010 , ISTALLATION CERTIFICATE* • CF-6R-MECH-25-HEI :frigerant Charge Verification - Standard Measurement Procedure (Page 1 of to Address: Enforcement Agency: Permit Number: 3951 AVENIDA VISTA BONITA, La Quinta CA 92253 1 City of La Quint a 12-757 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 adds ional 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 rew or replacement space -conditioning systems that utilize prescriptive compliance method. TMAH - Access Holes in Supplv and Return Plenums of Air Handler System Name or Identification/Tag System 1 System Location or Area Served Whole House 1 ® Yes ❑ No n 1 , 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 1 If 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 Fail ✓ ® Pass ✓ ❑Fail STMS`- Sensor on the Evaporator -,Coil System'Name-or Identification/Tag'Tjj.,0-0- -Sy`"stein 1-7117i-7 tPIA 3 ❑Yes The sensor is factory' installed, "orpeld installed according to manuf3eturer;s, . No specifications, or is installed by methods/specifications approved bt the Executive""` Director. r_ 4 B❑ Yes }The sensor wire is terminated with a standard mini plug suitable fo= co - Irnnection3to a , �No Ig -T Tfie sensor mini plug is, accessible'torthe'installmg,techmc;Panz $k s Z and the'HERS rater, without changing-the'airflow through the condenser coil'' 5 i ❑Yes'”: ❑ No i The sensor measures the saturation temperature of the coil within 1.3 degrees F Yes to.3; 4, -and 5 is a'pass. Enter N/A if STMS are not applicable..Otherwise enter Pass or„„Fail ✓ ®N/A ✓ [3 Pass { ✓ 13 Fail L STMS- Sensor on the Condenser Coil + System Name or Identification/Tag System 1 The sensor is factory installed, or field installed according to manu=acturer's 6 ❑ Yes. ❑ No specifications, or is installed by methods/specifications approved bti the Executive,' .. r Director. The sensor wire is terminated with a standard mini plug suitable fcr 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 ✓ ® N/A ✓ ❑ Pass ✓ ❑ Fail applicable. Otherwise enter Pass or Fail Reg: 212-A0036239A-M2500001A-0000 Registration Date/Time: 2012/07/18.17:09:33 HERS Provider: Ca10ERTS,.Inc. 2008 Residential Compliance Forms August 2009 .. r Reg: 212-A0036239A-M2500001A-0000 Registration Date/Time: 2012/07/18.17:09:33 HERS Provider: Ca10ERTS,.Inc. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS " Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5) . Site Address: I Enforcement Agency: Permit Number: 49951 AVENIDA VISTA BONITA, La Quinta CA 92253 City of La Quinta 12-757 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 aUditional form(s) for , any additional systems in the dwelling as applicable. • The system should be installed and charged in accordance with they manufacturer's specifications before starting this p ocedure. , • 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 a System Name or Identification/Tag SystemA (must be re -calibrated monthly)` ., ten- k� ''�A -^i�' �::�� - �r* C , �'' System Location or Area Served Whole House 7 1/2012 , ! p y( y .%T R'aP"�� �• be r -ca rted monthly) : .. '59-;� Outdoor Unit Serial # . 5912EO1091 dfif P ( ) suPPIy J : *�� _., Outdoor Unit Make Lennox 83 Outdoor.Unit Model . XC16-048-230-02 ' Nominal Cooling Capacity Btu/hr l' 48000 ' temperature (Treturn, wb)4_�, 1 is INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS " Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5) . Site Address: I Enforcement Agency: Permit Number: 49951 AVENIDA VISTA BONITA, La Quinta CA 92253 City of La Quinta 12-757 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 aUditional form(s) for , any additional systems in the dwelling as applicable. • The system should be installed and charged in accordance with they manufacturer's specifications before starting this p ocedure. , • 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 a System Name or Identification/Tag SystemA (must be re -calibrated monthly)` ., ten- k� ''�A -^i�' �::�� - �r* C , �'' System Location or Area Served Whole House 7 1/2012 , ! p y( y .%T R'aP"�� �• be r -ca rted monthly) : .. '59-;� Outdoor Unit Serial # . 5912EO1091 dfif P ( ) suPPIy J : *�� _., Outdoor Unit Make Lennox 83 Outdoor.Unit Model . XC16-048-230-02 ' Nominal Cooling Capacity Btu/hr l' 48000 ' temperature (Treturn, wb)4_�, 1 Date of Verification 7/7/2012 Evaporator saturation temperature 49 Cali bratidn- of Diagnostic Instruments Dat of Refrigerant Gauge Calibration d 7/1/2012 (must be re -calibrated monthly)` ., ten- k� ''�A -^i�' �::�� - �r* C , �'' ..YIF � rm«-'..,i' � .:Y�V.�y,y. Date of TherrnocoupleCalibration 7 1/2012 , ! p y( y .%T R'aP"�� �• be r -ca rted monthly) : .. '59-;� tl- .� �(must J. a� Measured Tertiperatures�(O F)_ /�&' _�> " . , - System Name or Identification/Tag +re � System 11 - � F• +��a k� ''�A -^i�' �::�� - �r* C , �'' ..YIF � rm«-'..,i' ' " B , i _ �ri� !+: Supply (edaporator leaving) -air dry bulbi tem erature ` T'° : .. '59-;� a� Measured Tertiperatures�(O F)_ /�&' _�> " . , - System Name or Identification/Tag +re � System 11 - � F• +��a k� ''�A -^i�' �::�� - �r* C , �'' ..YIF � rm«-'..,i' Measured Tertiperatures�(O F)_ /�&' _�> " . , - System Name or Identification/Tag +re � System 11 - � F• +��a k� ''�A -^i�' �::�� - �r* C , �'' ..YIF � rm«-'..,i' ' " B , i _ �ri� !+: Supply (edaporator leaving) -air dry bulbi tem erature ` T'° : .. '59-;� tl- .� , r4' dfif P ( ) suPPIy : *�� _., - Return (evaporator entering) air;dry-bulb 83 temperature {Tretum, db) .. JL Return (evaporator entering) air wet -bulb 63, a A, ' temperature (Treturn, wb)4_�, 1 S. Evaporator saturation temperature 49 (Tevaporator, sat) , Condensor saturation temperature 124 (Tcondensor, sat) - Suction line temperature (Tsuction) 74 Liquid Line Temperature (Tliquid) 118 Condenser (entering) air dry-bulb 80 temperature (Tcondenser, db) JL a A, ' S. INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page.3 of 5) Site Address: I Enforcement Agency: Permit Number: 49951 AVENIDA VISTA BONITA, La Quinta CA 92253 'City of La Quinta 12-757 Minimum Airflow Requirement H Temperature Split Method Calculations for determining Minimum Airflow Requirement for Reffigerant 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, 24.00 t. ti db - Tsupply, db C ' , Target Temperature Split from Table RA3.2-3 23 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: 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 coN airflow is measured, the value must be equzd to.or greater than the Calculated Minimum Airflow Requirement in the table below. Calculated Minimum Airflow Requirement (CFM) = Nominal Cooling Capacity (ton) X 300 (cfrr,/ton) System Name or Identification/Ta yto 9yi, S st7ftz1* 4Z Y� ` Calculated;Mi nimum Airflow Requirement (CFM) Measured Airflow,Tu�oRA .3 p ocedu es (EFk)4., Passes if measuredsairflow is greater than or. t••- e ual to the calculated minimum airflow. requirement: __1 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 = t. ti 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 -50F and +5°F _ Enter Pass or Fail Reg: 212-A0036239A'M2500001A-0000 ,:Registration Date/Time: 2012/07/18 17:09:33 HERS ?rovider: CalCERTS, Inc. .2008,Residential Compliance Forms , August 2009 t. ti Reg: 212-A0036239A'M2500001A-0000 ,:Registration Date/Time: 2012/07/18 17:09:33 HERS ?rovider: 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: 49951 AVENIDA VISTA'BONITA, La Quinta CA 92253 1 City of La Quinta 12-757 Subcooling Charge Method Calculations for Refrigerant Charge Verification. This procedure is recuired to be used: for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag System 1 + Calculate: Actual Subcooling = 6.0 Tcondenser, sat - Tliquid>• 25.0 Target Subcooling specified by manufacturer 6. - Calculate difference: 0 Actual Subcooling - Target Subcooling = 3-26 ' System passes if difference is between -3°F and.+3°F PASS Enter Pass or Fail . , r• Metering Device Calculations for Refrigerant Charge Verification. This procedure is required to be used for 1 System Name or Identification/Tag System 1 Calculate: Actual Superheat, 11 25.0 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, 11 25.0 Tsuction - Tevaporator, sat Enter allowable superheat range from . manufacture`r'`s specifications (or use range 3-26 ' between 4°F and 25°F if manufacturers specification is not available) , System passes if actualauperheat isrwithim�the allowable.superheatrangetfr�r �'^ t{tPASS f r• " r Enter Pass or;Fa� ` •" .. a .:. - j/) ��' .;,fir{{,;�� � '''s�?�t^�,�. ^. `o-. � b F T"aw.�i s` i„ "T+2;: rr�';�,�,� Y.,,a.`�€. 7.,ydG. , > � ., .. ., �,, � 3• C '4 �R C A - R.. .., r , • fie. -: �� — ,' . Reg: 212-A0036239A7M2500001A-0000• Registration Date/Time: 2012/07/18 17:09;33 HERS 3rovider: Ca10ERTS,,Inc. 2008 Residential Compliance Forms f , ' } s. • August 2009 !. .. ,' �'.,, .• �-� l.. '. —., mo-• • " a , INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5) ' Site Address: Enforcement Agency: Permit Number:, 49951 AVENIDA VISTA BONITA, La Quinta CA 92253 1 City of La Quint a 12-757 Standard Charge Measurement Summary: System shall pass both refrigerant charge criteria, metering device criteria (if applicable), and minimum tooling 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. ,a System 1 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5) ' Site Address: Enforcement Agency: Permit Number:, 49951 AVENIDA VISTA BONITA, La Quinta CA 92253 1 City of La Quint a 12-757 Standard Charge Measurement Summary: System shall pass both refrigerant charge criteria, metering device criteria (if applicable), and minimum tooling 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: r; Date Signed: 17/7/2012 Position With Company (Title): System meets all refrigerant charge and airflow Is this installation monitored by a Third Party Quality., Name of TPQCP (if applicable): ,* - requirements. PASS Enter Pass or Fail } , A A • b•i 1. 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). e 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 r 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 avai:able 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: r; Date Signed: 17/7/2012 Position With Company (Title): 686310 Is this installation monitored by a Third Party Quality., Name of TPQCP (if applicable): ,* - Control Program (TPQCP)? ❑ Yes ❑ No , . ' r Reg: 212-A0036239A-M2500001A-0000 Registration Date/Time: 2012/07/18 17:09:33 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms August 2009• HVAC Field Data Sheet Pg 1 oft Client Name 6Q/ L I�Y_ job # —LAF J Date Address '[21 5) /9 Lf Val , 73 O� i �y Ph # Technicians) .Q� c/-� Permit # Gauge/Thermocouple Calibration Date Split I Package I Some Ducts OWy ( All Ducts Only (Circle type ofwork) MECH=Q4 . ErfpmetiLDataONB I ZONE ZD�►E3 ZQNB4 System Location or Area Served O/C P0111r. Heating Equipment Make Heating Equipment Model L Z dU v if ARI Reference Number ` 33 9 '/ Z O Heating EquipmentAFUE . Dud Location (attic, crawlspace, etc.) 7)* C . Dud R Value (if ducts were installed). - Heating Load Heating Equipinent Output Capacity D 0 Z (/ 0 / U Condenser Make Condenser Model C/ D 11 - Z 1 G- Z- Size in Tons L -T SEER & EER CoolingLoad As- LI 0 r SCooling Cooling Capacity & & 21 Dud Tuft ! 0 'j- Dud leakage pretest result DoctLeakage FinalResult 424am/bmtopass(6%) Duct Leakage Final Result e6o CFM/tomo pm (is%) Pass using 60% leakage reduction? Pass using smoke and visual inspection? 3 IO C) PaSSIM Passmafl G J PaZIFA Paw[FA Few . MEd l or.mraiZ5 CooffiW Coil°Air flow & Pan..tili Draw . Measured Air Volume from Flow Grid or Hood NEW DUCTS Target 350 CFM/bon a CondenserTons CHmGEOUT Target: 300 CFM/bn x condenser Tons Measured air greater than Target? (Y/N) N Z d Fan Watt Draw Target: 058 watts/measured CFM Measured Watts less than Target? (YIN) Copyright 0 2011 EDS Energy Driven Sat dow, hm HVAC Field Data Sheet Pg2of2 Client Name1- �S &r -LZ job # 1 �&Z Date 717117 - Condenser / 7117 - Condenser Serial Number Supply air dry bulb temperature Return air dry bulb temperature Return air wet bulb.temperature Evaporator Saturation Temperature Condenser Saturation Temperature Suction Line Temperature Liquid Line Temperature Suction Pressure Liquid Pressure Actual Airflow Temperature Split Target Temperature Split from Table RA3.2.3 Passes if difference is t 3' of Target Temp (Y/1` Actual Subcooling (t 4' of Target to pass) Target Subcooling from Mfr. Actual Superheat (3 to 26* to pass) Outside air dry bulb temperature MEW �26-'Wefgh-ln pa g ft below 55' Actual Line Set length (ft) Mfrs Standard Line Set Length (ft) Length Difference = Correction Factor (ounces per foot) Target: Correction Factor x Length Difference System Charged to Target? (Y I .50 25, ZONE1 ZONEZ ZONE3 ZONE4 /2 FU/09/ Minimum amps 2 C Maximum amps 2!. Breaker size Compressor amps L U Return Static Pressure Supply Static Pressure Suooly Air Wet Bulb TemperatureJ Z .EE • ALL APPMCABLEBOMSON TMSFORNMUST BE COMPLETM FOR EACHIOR NOEXCEMNS • " Copyright 0 2011 EDS EherV Drtvm solations, las