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12-1426 (MECH)
4 P.O. BOX 1504 VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 12/12/12 Application Number: 12-00001426 Owner: Property Address: 54733 INVERNESS FERN JENNINGS APN: 775-091-063- - - 54733 INVERNESS Application description: MECHANICAL LA QUINTA, CA 92253 Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 6560 Contractor: D Applicant: Architect or Engineer: DIAL ONE'S ONE HOUR A/C G Q 2712 E. LA CADENA DRIVE RIVERSIDE, CA 92507 1 n (951)276-9744 1 P( Lic. No.: 878533 T. LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. Lic se^1Cl'ass: C20 License No.: 878533 Dater 0% fi ntractor. OWNER -BUILDER DECLARATION Ihereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: (_) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). (_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). ( ) I am exempt under Sec. , BAP.C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY • - I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: Lender's Address: LQPERMIT WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which. this permit is issued. 1 have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier EVEREST NATL Policy Number CA -10001300121 _ I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if 1 should become subject to the workers' compensation provisions of Section 3700 of th Labor Code, I shall forthwith comply with those provisions. ate: plicant' �. WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. - 1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application, the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives offthh' rctou"nty to enter upon the above-mentioned property for inspec ' urposes. af7 te: �/Si ature (Applicant or Agent): LQPERMIT Application Number 12-00001426 Permit . . . MECHANICAL Additional desc . Permit Fee . . . . 24.00 Plan Check Fee 6.00 Issue Date . . . . Valuation . . . . 0 Expiration Date 6/10/13 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 9.0000 EA MECH FURNACE <=100K 9.00 ---------------------------------------------------------------------------- Special Notes and Comments HVAC CHANGE -OUT: INSTALL FURNACE,INDOOR COIL. 2010 CODES. -------------------- =--------------------------------------------- Other Fees . . . . ... BLDG STDS ADMIN (SB1473) 7 --------- 1.00 Fee summary Charged Paid Credited ---------------------------------------- Due ----------------- Permit Fee Total 24.00 .00 .00 24.00 Plan -Check Total 6.00 .00 .00 6.00 Other Fee Total 1.00 .00 .00 1.00 Grand Total 31.00 .00 ..00 31.00 Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-iR-ALT-HVAC Climate Zones 10 - 15 Site Address: 54733 INVERNESS WAY La Quinta, CA 92253 Enforcement Agency: City of La Quinta Date: Dec 11, 2012 Permit #: Equipment Typel List Minimum Efficiency2 Duct insulation requirement Conditioned Floor Area Thermostat p Package Unit ® Furnace ® indoor Coil ® AFUE 78% p SEER ❑ COP [3HSPF 13R 6 (CZ 10-13) Served by system ®Setback If not already present, must be ❑ Condensing Unit 17 EER ❑ Resistance R 8 ❑ (� i4-1 S) �$� sf installed) ❑ Other I. 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-611 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-1R and CF-6R 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 oil and /or CF-611 forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS • Furnace CF-411 forms: MECH-21 and (for split systems) MECH-25 For Split Systems: Duct leakage < 15 percent; RC, CCA 5 300 CFM/ton (Minimum Air Flow Requirement), TMAH Exempted from duct leakage testing If: ❑ 1. Dud system was documented to have been previously sealed and confirmed through HERS verification, or ❑ 2. Duct systems with less than 40 linear feet in unconditioned space, or ❑ 3. Existing duct systems are constructed, Insulated or sealed with asbestos ❑ 4. The system will not be Ducted (Ie�Ductless MInIRSplit System)�(Also from Refrigerant Charge) _Exempt ❑ 2. New HVAC System Required Forms: P/11.' • Cut in or•.'Cha with, new ducts: (allll new new '" CF-6R forr s: MECH-04 MECW20 HERS and;(f r split systems) MECH=22-HERS, and dulling all news. equipment) ' r MECH 25SHERS / a 4k . - CF-4R forms: MECH-20 and; for split 'd P systems) MECH-22,°and MEGi-25 y . 'rte , ;,:' ! R_ , ; ,,, ,p .( For Split Systems: Duct leakage < 6'peroent; RC, CCA42 350 CFM/ton, FWD, TMAH, STMS, 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 and/or Indoor coil and/or furnace. No or some CF-6R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS CF-411 forms: MECH-20 and (for split systems) MECH-25 equipment changed. For Split Systems: Duct leakage < 6 percent; RC, CCA Z 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 p 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 Tide 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: Jim McEligot Signature: Jim McEligot Company: VENVEST BALLARD INC I Date: Dec 11, 2012 Address: 2712 EAST LA CADENA DRIVE License: 878533 City/State/Zip: RIVERSIDE / CA / 92507 Phone: (951) 276-9744 -u- vwu7DD1--vvvvvuyvu-uuuv Kegistration Date/Time: 2012/12/11 19:20:11 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms July 2010 Bin. # Crty of La Quinta Building Safety Division P.O. Box 1504,78-495 Calle Tampico La.Quinta, CA 92253- (760) 777-7012 Building Permit Application'and Tracking Sheet Permit # \A Project Address: T:YIV Owner's Name:. f A. P. Number. 715 _ CFA_ �7J 9 Address: "�37� a Legal Description: Contractor: LlJIA City, ST, Zip: L& V Tei hone: _ Address:31 1 Project Description: oze r AeQ City, ST, Zip: V-kuurcle LTelepLhon2 \1Man- City Lic. #: # : g j3 Arch., Engr., Designer Address: City., ST, Zip: Telephone: State Lic. #: Name of Contact Person: ��`�"' a r Construction Type• . Occupancy: Project type (circle one): New Add'n Alter Repair Demo Sq. FL: # Stories: #Univ: Telephone # of Contact Person: Estimated Value of Project APPLICANT: DO NOT WRITE BELOW THIS UNE # Submittal Req'd Rec'd TRACKNG PERMiT FEES Plan Sets Plan Check submitted Item Amount Strgctural Cafes.Reviewed, ready for corrections Plan Check Deposit. . Trnss Calcs. Called Contact person Pian Check Balance Title 24 Calci. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2r' Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.L H.O.A. Approval Plans resubmitted Grading 6(HOUSE:- 7jd Review; ready for carrectionsJissue Developer Impact Fee Planning APprmal; Called Contact Person Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees Prescriptive Certificate of Compliance: Residential CF -111 -ALT Residential Alterations r s Page 1 of 5 Project Name: Climate Zone # # of Stories Fern Jennings 15 2 General Information Site Address: 54733 Systeml Invemess Way La Quinta CA 92253 Enforcement Agency: La Quinta, City ofDate: 1/30/2013 Building Type p Single Family ❑ Multi Family Circle the Front Orientation:®, E, S, W, or degrees Conditioned Floor Area (CFA): 2500 Project Type: ❑� Alterations ❑ Envelope ❑ Fenestration ❑ Roof HVAC ❑ Table Replacement or Change Out ❑ Duct Replacement g ❑ Water Heater NOTE: This form is not to be used for Newly Constructed Buildings or Additions Insulation Values For Opaque Surfaces (for Furring use the Mass and Furring Strips Construction table below) Assembly Alteration ❑ Opening of framed cavity alone—Alterations that involve the opening of the framed cavity of a hall, ceiling, or floor must install the mandatory minimum insulation value per §150 for the altered assembly. Fill in Columns A —C and enter mandatory insulation value in Column H. ❑ Replacement of entire assembly— Replacement of an entire wall, ceiling, or floor assembly requires the installation of Component Package- D insulation values in Table 151-C. Fill in Columns A — J. Opaque Surface Details For the furred portioned of Mass Walls see Furring Strips Construction Table below. A B I C D E F G I H I I 11 J Proposed bee Note Standard Values From JA4 Table Tag/ �. Assemb ) all. Framing T 'ckness& � . 1, 1 3i1 1 dic Framed Continuous JA4 Proposed Assembly Assembly IDS or T __ d S th or um I e a Cell Values U -factor It v 0 UAssembly Final Mass Name or JA4 Table Thickness' ¢ 15°WE E o x ° _ ' _ ¢ ' —°o e:: 'LU Assembly Type' Number' > c c j e U-factore'7 Comment F-1 Note: For furred asse'inblies, cPccot�g fo — C oritinrrous l sl7i�it' n X -slue, see ggi a 4-3 and Eqr n For aI Mating f:trred walls use the Mass and Furring Construction ladle below. 1. For Tag/ID indicatethe dentrfication`na"thAmatchhe hu'Idin" plan2. Indicate the Assembly Name or type: RoloorsSlabs_C nwl Spn�Q- oors t e cInn'di a h Franreiype and Size: For Wood, Metal, Metal Buildings, Mass, en. see JA4 or other p s'679 frl ife, i,' sena lies. 3. Enter the thicknessfor mass in inches of coning tnemb enter T6�+or�r'i4 ; or Other 'or all other a� sembly description such as Concrete Sandwich Panel, Spandrel Panel, Logs, Straw Bali Panel and etc.... 4. Based on the Climate Zone; enter the Standard bifactor from—Tabled 51-B, C or D for each differen ssen�L 'ame.or typ e. 5. Enter the Table number that closely resembles the proposed assembly. 6. Enter the R -value that is being installed in the wall cavity or between the framing; otherwise, enter "0 ". 7. Enter the Continuous Insulation R -value for the proposed assembly; otherwise, enter "0 ". 8. Enter the row and column of the U factor value based on Column F Table Number and enter the Assembly U factor in Column J 9. The Proposed Assembly U factor, Column J, must be equal to or less than the Standard Ufactor in Column E to comply. Furring Strips Construction Table for Mass Walls Onl A I B I C I D I E F I G I H i J I K L M Proposed Properties of Masonry and Concrete Added interior or Exterior Insulation Walls From Reference in Furring Space from Reference Joint Appendix Table 4.3.5, 4.3.6, 4.3.7 Joint Appendix Table 4.3.13 g _ ?_1 U It v 0 UAssembly Final Mass Name or JA4 Table Thickness' ¢ 15°WE E o x ° _ ' _ ¢ ' —°o e:: 'LU Assembly Type' Number' > c c j e U-factore'7 Comment Registration Number: 313-AO01422OA-000000000-0000 Registration Date/Time: 01/30/201310:54:06 HERS Provider: CBPCA 2008 Residential Compliance Forms August 2009 Prescriptive Certificate of Compliance: Residential CF -1 R -ALT Residential Alterations rt (Page 2 of 5) Project Name: Climate Zone # # of Stories Fern Jennings 115 2 ass and Furring Strips Construction(footnotes) 1. Indicate the type of assembly to include; Hollow Unit Masonry Walls, Solid Unit Masonry, Solid Concrete Walls, Etc. Additional assemblies can be found Reference Joint Appendix JA4. 2. This is the U -Factor based on the thickness of the assembly in inches. 3. The R -value of the insulation to be added on the interior or exterior of the assembly. 4. The Calculated R- Value is the R -value of the furred out section of the assembly. 5.-6. The Fina! Assembly is calculated using Equation 4-2 or Equation 4-4of the Reference Joint Appendix JA4. The equation is the inverse of Column D added to Column I. Column K is the inverse froth column J. 7. Insert the calculated U- actor value on to the Opaque Sur ace Details in Column J FENESTRATION PROPOSED AREAS ❑ Replacing window alone — Replacement windows shall meet the U -Factor and SHGC Value requirements of Component Package D in Table 151-C. The Total Fenestration and West facing Area requirements are not applicable. ❑ Adding 50ft2 or less of window area — Newly installed windows shall meet the U -Factor and SHGC Value requirements of Component Package D in Table 151-C. ❑ Adding more than 50ft2 of window area — Newly installed windows shall meet the U -Factor and SHGC Value and the Fenestration Area requirements of Component Package D in Table 151-C. Complete the Altered Fenestration Allowed Area Table on Page 2 of the CF- IR -ALT Fenestra> iFrn r�e- lin si111 iim NFRC Default or (Window, GlasWoororSkyli ht) m --mg Aputh, We )* ft2-faetor2•3 S�iGC2 ° Values i, tounu G Allowed fl L � rel 1. Fenestration area is the area of total glaed prod:ii°l'7i.e. glass plus ft•3rite). Exc•epl on NKhar a door is less t an SO% glas , the fenestration area may be the glass area plus a "2 inch fianr round tglass. 2. Enter value from Component Package D Requiremen s rn To le 15! C. - 3. Actual fenestration products installed and as indicated in C -6R-EIV Form shall be equivalent to or have a lot+ et U fact i and/or a lower SHGC value than that specified on the CF- I R ALT Form. 4. Submit a completed WS -31? Form if a reduced SHGC is calculated with exterior shading. S.Ifa licable at this stage enter "NFRC"for NFRC Certified windows or are CEC "Default" values found in Table 116-A or B. ALTERED FENESTRATION ALLOWED AREAS (Complete if more than 50ftr of fenestration is added) A B C D E F G Allowed Existing Fenestration Total Area CFA of Entire % of Fenestration Area Fenestration Allowed Proposed Areal Dwelling CFA Area Removed Area Added (A x B) (E -D) + C Total Fenestration Area (ft') .20 > West Fenestration Area (Required in .05 > CZ's 2,4&7-15) 1— 1. West Fenestration Area includes west -sloping skylights and any skylights with a pitch less than 1:12. 2. West facing glazing area removed cannot be "counted" twice. " In order to distribute the west glazing area removed to the other orientations, input the west glazing area removed in the Total Fenestration Area row, column D. 3. Include the Proposed Area of the West facing fenestration in both Area columns below. 4. To meet compliance, the Proposed Area must be less than orequal to the Total Allowed Area for BOTH the Tota! and West Fenestration Areas. Registration Number: 313-AO01422OA-000000000-0000 Registration Date/Time: 01/30/201310:54:06 HERSProvider: CBPCA 2008 Residential Compliance Forms August 2009 Prescriptive Certificate of Compliance: Residential CF -I R -ALT Residential Alterations TI (Page 3 of 5 Project Name: Climate Zone # # of Stories Fern Jennings 15 2 ROOFING PRODUCTS (COOL ROOFS) §151(1)12 When the area of exterior roof surface to be replaced exceeds more than 50% of the existing roof area, or more titan 1,000 f , whichever is less, the new roofing area must meet the roofing product "Cool Roof" requirements of §151(b)IHi, 152(b)1Hii, or 151(b)IHiii. Check applicable alternative or exception below if the roof alteration is exempt from the roofing product "Cool Roof' requirements. Note: If any one of the alternatives or exception below is checked, the Aged Solar Reflectance and Thermal Emittance requirements for roofing products in §118(1) are not applicable. Do not flit table below. ❑ Cool Roofs Not Required in Climate Zones 1-12, 14, and 16 with a Low Sloped. Less or 2:12 pitch. ❑Cool Roofs Not Required in Climate Zones 1 through 9 and 16 with a Steep -Sloped Roofs (pitch greater than 2:12) and product unit weight less than 5lb/ft2. Alternatives to §152(b)1Hi and §152(b)Hii, Steep -slope roof (pitch > 2:12) ❑ Insulation with a thermal resistance of at least 0.85 hr•ftZ•°FBtu or at least a 3/4 inch air -space is added to the roof deck over an attic; or ❑ Existing ducts in the attic are insulated and sealed according to §151(f)10; or ❑ in climate zones 10, 12 and 13, with 1 f:2 of free ventilation area of attic ventilation for every 150 ftz of attic floor area, and where at least 30 percent of the free ventilation area is within 2 feet vertical distance of the roof ridge; or ❑ Building has at least R-30 ceiling insulation; or § 151�(fpJ2; p�r� �p ❑ Building has rat',t b r the attic rt,�eeting qui111d ❑ Building has n dr i 'li Perf ti, �111f 1!a n ❑ In climate zones 10, 1,i, -3-and.Q R 3 regre.at, r deck insulation above vented attic. Exception �2: to §152(b)1 F1iii, Low -slope roof (pitch .i ❑ Building has no ductstin t}`h attic.. _ Other Exceptions tri V ❑ Roofing area co Bred b buildmgmnteg ated; phopv cyiltaic panels andpolar thermal pane ,are�e.xem from the below Cool Roof criteria. al�least is ❑ Roof constructions that l ve=thermal rpe ;s over,the rodf membrane }vth 25 Ib/, e m-he=below-Gool Roof criteria. Note: If no CRRC-I labels available is ompli ce m thod cannot be used, use the P rformance Ap roach to show coniptliance, otherwise, Check thea boz below Exem fron�.the "Cg1ol applicable rf t 1 i oting Produ tS Roof' Re vire t 1 R� f Slope Product weight Pra lu t: ged�S`olar' Thermal CRRC Product ID Number Z: 2 12'1 < 51Ij%ft51b/�8" f. e_� erfl'ectance'', Emil[tance SRIS 11 0 El 0 11 ❑ ❑ E] ❑ 04 ❑ ❑ ❑ ❑ ❑4 ❑ ❑ 1 ❑ ❑ ❑4 ❑ or ❑ ❑ ❑4 1. The CRRC Product ID Number can be obtained from the Cool Roof Rating Council's Rated Product Directory at wrvw.coolroofs.orQ/products/search.php 2. Indicate the type of product is being used for the rooftop, i.e. single -ply roof, asphalt roof, metal roof, etc. 3. If the Aged Reflectance is not available in the Cool Roof Rating Council's Rated Product Directory then use the initial Reflectance value from the same directory and rise the equation (0.2+0.7(pi„igat- 0.2) to obtain a calculated aged value. Where p is the Initial Solar Reflectance. 4. Check box if the Aged Reflectance is a calculated value rising the equation above. 5. Calculate the SRi value by using the SRI- Worksheet at hamllwww.energy, ca.eov/title24/and enter the resulting value in the SRI Column above and attach acopy of the SRI- Worksheet to the CF -IR. To apply Liquid Field Applied Coatings, the coating must be applied across the entire roof surface and meet the dry mil thickness or coverage recommended by the coatings manufacturer and meet minimum performance requirements listed in § I 18(i)4. Select the applicable coating: ❑ Aluminum -Pigmented Asphalt Roof Coating ❑ Cement -Based Roof Coating 113 Other Registration Number: 313-AO01422OA-000000000-0000 Registration Date/Time: 01/30/201310:54:06 HERSProvider: CBPCA 2008 Residential Compliance Forms August 2009 Prescriptive Certificate of Compliance: Residential CF -IR -ALT Residential Alterations ' Page 4 of 5 Project Name: Climate Zone # # of Stories Fern Jennings 15 2 HVAC SYSTEMS - HEATING List water heaters an boilers for both domestic holt watei (DHiI) healers an" hvdronic pace heating aVividaal dwelling HW heaters must be gas or propanefired, and°nary not ex eed 5��0 pallor sH water pipe ittsulati, ra from f/? DHW h to the kitchen( and ry all underground hot Minimum Duct or Piping Configuration Heating Equipment Type and Capacity 1,2,3 Efficiency (AFUE or HSPF) Distribution Insulation Type and Location R -Value Thermostat (Central, Split, Type Space, Package or Hydronic) Furnace, 60000 80 AFUE Ducted, SetBack Split LIQ" 1. Indicate Heating Type (Central Furnace, Wall Furnace, Heat pump, Boiler, Electric Resistance, etc) 2. Electric resistance heating is allowed only in Component Package C, or except where electric heating is supplemental (i.e., if total capacity < 2 KW or 7,000 Btu/hr electric heating is controlled by a time -limiting device not exceeding 30 minutes). See §151(b)3 exception. 3. Refer to the HERS Verification section on Page 4 of the CF -/R -AL T Form for additional requirements and check applicable boxes. 4. Indicate Type or Location (Ducts, Hydronic in Floor, Radiators, etc.) HVAC SYSTEMS - COOLING not allow the installation of a recirculating water heating system for single dwelling units. Minimum Efficiency Duct or Piping Configuration Cooling Equipment Type and Capacity 1,2 (SEER/EER or Distribution Insulation COP) Type and Location R -Value Thermostat Tye (Central, Split, Space, Package or Hydronic) AirConditioner, 2 00 _ .1E_ 13 SEER D cte t, SetBack Split toialuii_ 1. Indicate Cooling Type,,(1X3`Ci pump, v o t ■ 2. Refer to the HERS�o erifrcatiorr section or JPP ge r7 '' t al , r { l axes. 3. Indicate Tye oroccuiota (D ct�,ydyd�ro aic in /loor_.&diators, etc.) _ I r I - �J V v _%%, WATER HEA'1(;'ING�, List water heaters an boilers for both domestic holt watei (DHiI) healers an" hvdronic pace heating aVividaal dwelling HW heaters must be gas or propanefired, and°nary not ex eed 5��0 pallor sH water pipe ittsulati, ra from f/? DHW h to the kitchen( and ry all underground hot water pipes is required in all com one acka a all climate rare . ] Water Healer Type/Fuel Distribution Type (� Num�i i n Energ�Fa toror External Tank Insulation Type' (Standard, Recirculating)' System Capacity (gal) , The -E cienc] R-Value3 LIQ" 1. Indicate Type (Storage Gas, Heat Pump, Instantaneous, etc.) 2. Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of §150(n). The Prescriptive requirements do not allow the installation of a recirculating water heating system for single dwelling units. 3. The external water heating tank and i es shall be insulated to meet the requirements of §1506). SPECIAL FEATURES The enforcement agency should pay special attention to the Special Features specified in this checklist below. These items may require written justification and documentation and special verification. NEW ROOF ASSEMBLY - Radiant Barrier The radiant barrier requirement of §151(f)2 does not apply to roof alterations. Slab Edge (Perimeter) Insulation D YES El NO YES: In Climate Zone 16 in Component Packages D, R-7 insulation is required. Heated Slab insulation El YES 0 NO YES: Slab edge insulation required for all heated slabs in all Climate Zones. See details in Table 118-A of the standards. Raised Slab Insulation Q YES 0 NO YES: In Climate Zones 1, 2, 11, 13, 14 & 16, R-8 insulation is required; in Climate Zones 12 & 15, R-4 is required under component Package D. Thermal Mass To obtain Compliance Credit for the installation of thermal mass, use the Performance A roach. Registration Number: 313-AO01422OA-000000000-0000 Registration Date/Time: 01/30/2013 10:54:06 HERSProvider: CBPCA 2008 Residential Compliance Forms August 2009 Prescriptive Certificate of Compliance: Residential CF -IR -ALT Residential Alterations Page 5 of 5 Project Name: Climate Zone # # of Stories Fern Jennings 15 2 HERS VERIFICATION SUMMARY The enforcement agency should pay special attention to the HERS Measures specified in this checklist below. A completed and signed CF -41? Form for all the measures specified shall be submitted to the building inspector before final inspection. Duct Sealing & Testing HERS verification is required for this measure. YES ❑ NO YES: In Climate Zones 2 and 9-16, if more than 40 linear feet of new or replacement ducts are installed in unconditioned space, the ducts are to be sealed per § 152(b)1 Dii and the newly installed ducts are to be insulated per § 15I(f)10. ❑ EXCEPTION: Existing duct systems that are extended, which are constructed, insulated or sealed with asbestos. ❑ YES [3 NO YES: In Climate Zones 2 and 9-16, if the existing space -conditioning system (HVAC equipment and ducting) is replaced, the ducts are to be sealed per § 152(b)1 Di. ❑ YES ❑ NO YES: In Climate Zones 2 and 9-16, if the existing HVAC equipment is replaced (including the replacement of the air handler, outdoor condensing unit of a split system, cooling or heating coil, or the furnace heat exchanger) the ducts are to be sealed per § 152(b) I E. 0 EXCEPTION: Duct systems that are documented to have been previously sealed confirmed through HERS verification in accordance with procedures in the Reference Residential Appendix RA3. ❑ EXCEPTION: Duct systems with less than 40 linear feet in unconditioned space. ❑ EXCEPTION: Existing ducts stems constructed, insulated or sealed with asbestos. Refrigerant Charge -Split System HERS verification is required for this measure. 0 YES El NO ES: mate Zones12 and whe th eexistin HV a ui nt is replaced including the replacement of the air 1 '6 rc1 c en t� ; 1411 pu �' • = nee, or the furnace heat .,,rexchange, a refxigccan c e measure ent sh verified per §,L52(b) 1 F. .; Central Fan Integrate CFl);Vyentilati ` �r 1,70 , % :1 x i o n The ventilation re orements of §'1150(9) d`o lot ap ly to existing residential homes. Ducted Split Systems -�ir Conditioners and`Heat Pumps: Airflow �H,F��rificatzo • required for this measure. 13 YES 0 NO YES: In 10 throtgh5, v\fien the existing space-conditaai s_vst (HVAC equipment and ducting) is replac�, the air low an an v`att draw shall be verified per § 52(b)l mee.4therequ renlen(s of §151(07B. Documentation Author's Declaratioi Statem nt M: • I certify that this Certificate of Com liane doc—unvenr`ation is ibeurate.andNom _tete. Name: Ruth Debrick Signature: Ruth Debrick Y Company: Venvest Ballard/One Hour Air DaTe. 1/30/2013 Address: 3030 Myers St,Street If Applicable ❑CEA or [3CEPE (Certification #): City/State/Zip: Riverside California 92503 Phone: 951-276-9744 Responsible Building Designer's Declaration Statement • I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the building design identified on this Certificate of Compliance. • I certify that the energy features and performance specifications for the building design identified on this Certificate of Compliance conform to the requirements of Title 24, Parts I and 6 of the California Code of Regulations. • The building design features identified on this Certificate of Compliance are consistent with the information provided to document this building design on the other applicable compliance forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application. Name: Signature: Company: Date: 1/30/2013 Address: License: 878533 City/State/Zip: Phone: t or assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300. Registration Number: 313-AO01422OA-000000000-0000 Registration Date/Time: 01/30/201310:54:06 HERS Provider: CBPCA 2008 Residential Compliance Forms August 2009 Prescriptive Certificate of Compliance: Residential CF -111 -ALT Residential Alterations Page l of 5) Project Name: Climate Zone # # of Stories Fern Jennings 115 2 General Information Site Address: 54733 System2 Invemess Way La Quinta CA 92253 Enforcement Agency: La Quinta, City of Date: 1/30/2013 Building Type El Single Family ❑ Multi Family Circle the Front Orientation:®, E, S, W, or degrees Conditioned Floor Area (CFA): 2500 Project Type: 0 Alterations ❑ Envelope ❑ Fenestration ❑ Roof ❑ HVAC Table Replacement or Change Out ❑ Duct Replacement ❑ Water Heater NOTE: This form is not to be used for Newly Constructed Buildings or Additions Insulation Values For Opaque Surfaces (for Furring use the Mass and Furring Strips Construction table below) Assembly Alteration ❑ Opening of framed cavity alone–Alterations that involve the opening of the framed cavity ofa wall, ceiling, or floor must install the mandatory minimum insulation value per §150 for the altered assembly. Fill in Columns A –C and enter mandatory insulation value in Column H. ❑ Replacement of entire assembly– Replacement of an entire wall, ceiling, or floor assembly requires the installation of Component Package- D insulation values in Table 151-C. Fill in Columns A – J. Opaque Surface DetailS For the furred portioned of Mass Walls see Furring Strips Construction Table below. A' B C D E F G I H I I i J Proposed See Note Standard Values From JA4 Table Tag/ Assemb + '•' ' Framing T 'ekness 44 �f601i'' !041.01-Jork9funity'l0-*1, Framed Continuous JA4 Assembly Proposed Assembly ID' or T N R a Cell Value" U-factor9 r0 U v .�+ °' > R U Assembly �v j o c •° t E- on 0 > ;, T� Final Mass Thickness' Name or JA4 Table T e' Number' > y 2 75 c x E ¢ E c ¢ > Assembly U -factor,' Comment .; Note: For fzn•red asseit*blies. Jccountinkfo—r C"anthnrous Ynt a7' n Xvahre, see iYg� A4-3 and Ecji n t�c 1, Foalculatingg fiirr�lls use the Mass and Furring Construction tale belol�. jr j 1. For Tag//D indicatestkie ide, tification' nd'tie thatLatch s the buildin' plans �� �j 2. Indicate the Assembly Name or type. Ro .'Ceitin ! is, Floors, Stabs-Grawt Space- oors qd `47f /ndicat' e.theJ�F'rame'rype and Size: For Wood, Metal, Metal Buildings, Mass, en r 2x4 x6, or el see JA, a for other ghke f acne ti .. hp ssem 3. Enter the thickness for mass in inches or pacing a en f''aming 9M emli r enter. 6�orz� or Other or all other a� sembly description such as Concrete Sandwich Panel, Spandrel Panel, Logs, St i iv Bali Panel and etc.... 4. Based on the Climate Zone; enter the Standard U factor from–Table-+151-B, C or D for each differenssenzb_ty�ame.or type. 5. Enter the Table number that closely resembles the proposed assembly. 6. Enter the R -value that is being installed in the wall cavity or between the framing; otherwise, enter "0". 7. Enter the Continuous Insulation R -value for the proposed assembly; otherwise, enter "0 ". 8. Enter the row and column of the U factor value based on Column F Table Number and enter the Assembly U factor in Column J 9. The Proposed Assembly U factor, Column J, must be equal to or less than the Standard U factor in Column E to comply. Furring Strips Construction Table for Mass Walls Only A I B I C T D E F G H i J I K L M Proposed Properties of Masonry and Concrete Added Interior or Exterior Insulation Walls From Reference in Furring Space from Reference Joint Appendix Table 4.3.5, 4.3.6, 4.3.7 Joint Appendix Table 4.3.13 N R N G N r0 U v .�+ °' > R U Assembly �v j o c •° t E- E= `o 0 > ;, T� Final Mass Thickness' Name or JA4 Table T e' Number' > y 2 75 c x E ¢ E c ¢ > Assembly U -factor,' Comment Registration Number: 313-A0014222A-000000000-0000 Registration Date/Time: 01/30/2013 11:08:47 HERS Provider: CBPCA 2008 Residential Compliance Forms August 2009 Prescriptive Certificate of Compliance: Residential CF -IR -ALT Residential Alterations ' Page 2 of 5 Project Name: Climate Zone # # of Stories Fern Jennings 15 2 Mass and Furring Strips Construction(footnotes) 1. Indicate the type of assembly to include; Hollow Unit Masonry Walls, Solid Unit Masonry, Solid Concrete Walls, Etc. Additional assemblies can be found Reference Joint Appendix JA4. 2. This is the U -Factor based on the thickness of the assembly in inches. 3. The R -value of the insulation to be added on the interior or exterior of the assembly. 4. The Calculated R- Value is the R -value of the furred out section of the assembly. 5.-6. The Fina! Assembly is calculated using Equation 4-2 or Equation 4-4of the Reference Joint Appendix JA4. The equation is the inverse ofColumn D added to Column I. Column K is the inverse from column J. 7. Insert the calculated U- actor value on to the Opaque Sur ace Details in Column J FENESTRATION PROPOSED AREAS ❑ Replacing window alone — Replacement windows shall meet the U -Factor and SHGC Value requirements of Component Package D in Table 151-C. The Tota! Fenestration and West facing Area requirements are not applicable. ❑ Adding 50ft2 or less of window area — Newly installed windows shall meet the U -Factor and SHGC Value requirements of Component Package D in Table 151-C. ❑ Adding more than 50fe of window area — Newly installed windows shall meet the U -Factor and SHGC Value and the Fenestration Area requirements of Component Package D in Table 151-C. Complete the Altered Fenestration Allowed Area Table on Page 2 of the CF -IR -ALT Fenest (Window, G�oOrrrcell!1�11 or e'�'�i "' s " r m NFRC or Default uth, t -- Welt) ft2 factorl,3 Si-1GCZ, ,4 Values j� D E F G 1. Fenestration area is the area of total glatZed produ`Ti.e. glass plus fine . F.xcept[0h:'�17LLter4t ,dooi is less.than*50%glass, the fenestration area may be the glass area plus a "2 inc fi•amrou_ndth�iglass. }' 2. Enter value from Component Package D Requiremensn Taff le 151 @-C 3. Actual fenestration products installed and as indicated in C -6R-EA V Form shall be equivalent to or have ato U -f act I r and/or a lower SHGC value than that specified on the CF -IR ALT Form. 4. Submit a completed WS -3R Form if a reduced SHGC is calculated with exterior shading. 5.Ifopplicable at this stage enter "NFRC" or NFRC Certified windows or are CEC "Default" values found in Table 116-A or B. ALTERED FENESTRATION ALLOWED AREAS (Complete if more titan 50ft1 of fenestration is added) A B C D E F G Allowed Existing Fenestration Total Area CFA of Entire % of Fenestration Area Fenestration Allowed Proposed Areal Dwelling CFA Area Removed Area Added (A x B) (E -D) + C Total Fenestration Area (ft) .20 > West Fenestration Area (Required in .05 > CZ's 2,4&7-15) — 1. West Fenestration Area includes west -sloping skylights and any skylights with a pitch less than 1:12. 2. West facing glazing area removed cannot be "counted" twice. " In order to distribute the west glazing area removed to the other orientations, input the west glazing area removed in the Tota! Fenestration Area row, column D. 3. Include the Proposed Area of the West facing fenestration in both Area columns below. 4. To meet compliance, the Proposed Area must be less than orequal to the Tota! Allowed Area for BOTH the Total and West Fenestration Areas. Registration Number: 313-A0014222A-000000000-0000 Registration Date/Time: 01/30/2013 11:08:47 HERSProvider: CBPCA 2008 Residential Compliance Forms August 2009 Prescriptive Certificate of Compliance: Residential CF -IR -ALT Residential Alterations ' Page 3 of 5 Project Name: Climate Zone # # of Stories Fern Jennings 15 2 ROOFING PRODUCTS (COOL ROOFS) §151012 When the area of exterior roofsurface to be replaced exceeds more than 50% of the existing roof area, or more than 1,000 f , whichever is less, the new roofing area must meet the roofing product "Cool Roof" requirements of §152(6)1 Hi, 152(6)1 Hii, or 152(b)IHiii. Check applicable alternative or exception below if the roof alteration is exempt from the roofing product "Cool Roof' requirements. Note: If any one of the alternatives or exception below is checked, the Aged Solar Reflectance and Thermal Emittance requirements for roofing products in ,¢118(1) are not applicable. Do not fill table below. ❑ Cool Roofs Not Required in Climate Zones 1-12, 14, and 16 with a Low Sloped. Less or 2:12 pitch. ❑Cool Roofs Not Required in Climate Zones 1 through 9 and 16 with a Steep -Sloped Roofs (pitch greater than 2:12) and product unit weight less than 5lb/ft2. Alternatives to §152(b)1Hi and §152(b)Hii, Steep -slope roof (pitch > 2:12) ❑ Insulation with a thermal resistance of at least 0.85 hr. ft2-OF/Btu or at least a 3/4 inch air -space is added to the roof deck over an attic; or ❑ Existing ducts in the attic are insulated and sealed according to §151(f)10; or ❑ in climate zones 10, 12 and 13, with 1 112 of free ventilation area of attic ventilation for every 150 ftZ of attic floor area, and where at least 30 percent of the free ventilation area is within 2 feet vertical distance of the roof ridge; or ❑ Building has at least R-30 ceiling insulation; or ❑ Building has ra ' t b ter the attic Meeting gwr�e en gf§151(!)2; ❑ Building has n duc t , mile u e ' in ( ,e.ir f o ° .'a� ❑ in climate zones 10, Uj -3=and,�4, R-3 rr gcea�r deck ins u ation ab`o�e.vented attic. Exception to §152(b 111iii, Low -slope roof (Pitch C n, �; c r , , i n ❑ Building has ri?ducNn- a attic. _ Other Exceptions 'N!+' ❑Roofing area covered b building. irate ted; photovoltaic panels and solar thermal panels. �a e.xem • t from the below Cool Roof criteria. ❑ Roof a�gleast constructions that liave th&al !mass over,the ro f membrane wtth 25 Ib/, is ex'r m m herbelow-cool Roof criteria. Note: If no CRRC-I label is available ,tliis"compli, nce m thud cannot be used, use the Pyy rformance Ap r'oach to show compliance, otherwise, Check theapplicable box belo�Exen�ipt from the g�otin Products "Colo) Roof, Re vire emmt CR -RC Product ID Number R4�f� Slope �_<-2�12`+>+12 Product Weight, < Slb%ft Slb"/tt"'+4'y Pro d<' et _ems ed_SoI r' eectance3i;' Thermal Emiitance 5 SRI ❑ ❑ ❑A ❑ ❑ .r, ❑ ❑ ❑ ❑ ❑4 ❑ ❑ ❑ ❑ ❑4 ❑ ❑ ❑ ❑ ❑4 ❑ ❑ ❑ ❑ ❑4 1. The CRRC Product 1D Number can be obtained from the Cool Roof Rating Council's Rated Product Directory at www.coolroofs.orelproducts/search.php 2. Indicate the type of product is being used for the rooftop, i.e. single -ply roof, asphalt roof, metal roof, etc. 3. If the Aged Reflectance is not available in the Cool Roof Rating Council's Rated Product Directory then use the Initial Reflectance value from the same directory and rise the equation (0.2+0.7(pini1i&— 0.2) to obtain a calculated aged value. Where pis the Initial Solar Reflectance. 4. Check box if the Aged Reflectance is a calculated value rising the equation above. 5. Calculate the SRI value by using the SRI- Worksheet at hitp://ivww.enereuca.gov/title24/and enter the resulting value in the SRI Column above and attach atopy of the SRI- Worksheet to the CF -IR. To apply Liquid Field Applied Coatings, the coating must be applied across the entire roof surface and meet the dry mil thickness or coverage recommended by the coatings manufacturer and meet minimum performance requirements listed in § 118(i)4. Select the applicable coating: ❑ Aluminum -Pigmented Asphalt Roof Coating Cement-Based Roof Coating TO ❑ Other Registration Number: 313-A0014222A-000000000-0000 Registration Date/Time: 01/30/201311:08:47 HERSProvider: CBPCA 2008 Residential Compliance Forms August 2009 Prescriptive Certificate of Compliance: Residential CF -IR -ALT Residential Alterations (Page 4 of 5 Project Name: Climate Zone # # of Stories Fern Jennings 115 2 HVAC SYSTEMS - HEATING List water heaters and. boilersfor both domestic hdtt watei (DHiI) heaters an " hvdronic pace heating. Inflividual dwelling DHW heaters must be gas or propane fired, and may not -e. eed 0 gallon H� water pipe i sulati n from Ih DHW h to the kitch n( and b all underground hot is in Minimum Duct or Piping Distribution Type Configuration Heating Equipment Type and Capacity 1,2,3 Efficiency (AFUE or HSPF) Distribution Insulation Type and Location' R -Value Thermostat Type (Central, Split, Space, Package or Hydronic) Furnace, 66000 80 AFUE Ducted, SetBack Split L Indicate Heating Type (Central Furnace, Wall Furnace, Heat pump, Boiler, Electric Resistance, etc) 2. Electric resistance heating is allowed only in Component Package C, or except where electric heating is supplemental (i.e., if total capacity < 2 KW or 7,000 Btu/hr electric heating is controlled by a time -limiting device not exceeding 30 minutes). See §151(b)3 exception. 3. Refer to the HERS Verification section on Page 4 of the CF -/R -ALT Foran for additional requirements and check applicable boxes. 4. Indicate Type or Location (Ducts, Hydronic in Floor, Radiators, etc.) HVAC SYSTEMS - COOLING 3. The external water heating tank and i es shall be insulated to meet the requirements of §1506). Minimum Cooling Equipment Type and Capacity 1,2 Efficiency Duct or Piping (SEER/EER or Distribution Insulation COP) Type and Location R -Value Thermostat Tye Configuration (Central, Split, Space, Package or Hydronic) AirConditioner,.4 00 i ; _ 13 SEER g cte a _ _ t — SetBack Split /. Indicate Cooling Typa,(NTC-HeaaNpump 1 o mg tc • 2. Refer to the HERSAerlfrcafion section o Page ' i e�_I _' r7 i r i��tt al r t on.s. 3. Indicate Tye or 1 ocation (Ducts, Jd)dro,;tic in loo�adiators, etc.) _ 1 f 1 - v V 1,J ,: _%.1 WATER HEATING-, `7 List water heaters and. boilersfor both domestic hdtt watei (DHiI) heaters an " hvdronic pace heating. Inflividual dwelling DHW heaters must be gas or propane fired, and may not -e. eed 0 gallon H� water pipe i sulati n from Ih DHW h to the kitch n( and b all underground hot is in water pipes re uired all com onerlr ackckg s�ity all climate zone Water Heater Type/Fuel Distribution Type N'(4um'b'er• n "t Erie 'yor External Tank insulation Type' (Standard, Recirculating)2 System Capacity (gal) , Thernial l'fi_ciency� R-Value3 1. Indicate Type (Storage Gas, Heat Pump, Instantaneous, etc) 2. Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of §150(n). The Prescriptive requirements do not allow the installation of a recirculating water heating system for single dwelling units. 3. The external water heating tank and i es shall be insulated to meet the requirements of §1506). SPECIAL FEATURES The enforcement agency should pay special attention to the Special Features specified in this checklist below. These items may require written justification and documentation and special verification. NEW ROOF ASSEMBLY - Radiant Barrier The radiant barrier requirement of § 151(f)2 does not apply to roof alterations. Slab Edge (Perimeter) Insulation 0 YES 0 NO YES: In Climate Zone 16 in Component Packages D, R-7 insulation is required. Heated Slab Insulation E3 YES 0 NO YES: Slab edge insulation required for all heated slabs in all Climate Zones. See details in Table 118-A of the standards. Raised Slab Insulation Q YES 0 NO YES: In Climate Zones 1, 2, 11, 13, 14 & 16, R-8 insulation is required; in Climate Zones 12 & 15, R-4 is required under component Package D. Thermal Mass To obtain Compliance Credit for the installation of thermal mass, use the Performance Approach. Registration Number: 313-A0014222A-000000000-0000 Registration Date/Time: 01/30/201311:08:47 HERSProvider: CBPCA 2008 Residential Compliance Forms August 2009 Prescriptive Certificate of Compliance: Residential CF -IR -ALT Residential Alterations ' Page 5 of 5 Project Name: Climate Zone # # of Stories Fern Jennings 15 2 HERS VERIFICATION SUMMARY The enforcement agency should pay special attention to the HERS Measures specified in this checklist below. A completed and signed CF -4R Form for all the measures specified shall be submitted to the building inspector before final inspection. Duct Sealing & Testing HERS verification is required for this measure. 0 YES ❑ NO YES: In Climate Zones 2 and 9-16, if more than 40 linear feet of new or replacement ducts are installed in unconditioned space, the ducts are to be sealed per §I52(b)IDii and the newly installed ducts are to be insulated per §151(f)l0. ❑ EXCEPTION: Existing duct systems that are extended, which are constructed, insulated or sealed with asbestos. ❑ YES (] NO YES: In Climate Zones 2 and 9-16, if the existing space -conditioning system (HVAC equipment and ducting) is replaced, the ducts are to be sealed per § 152(b) I Di. ❑ YES ❑ NO YES: In Climate Zones 2 and 9-16, if the existing HVAC equipment is replaced (including the replacement of the air handler, outdoor condensing unit of a split system, cooling or heating coil, or the furnace heat exchanger) the ducts are to be sealed per § 152(b) i E. 0 EXCEPTION: Duct systems that are documented to have been previously sealed confirmed through HERS verification in accordance with procedures in the Reference Residential Appendix RA3. ❑ EXCEPTION: Duct systems with less than 40 linear feet in unconditioned space. ❑ EXCEPTION: Existing ducts stems constructed, insulated or sealed with asbestos. Refrigerant Charge -Split System HERS verification is required for this measure. El YES El N ES: mate Zones,2 and . wlta th eacistin HV e ui nt is replaced (including the replacement of the air ual,1 r d en ri t� js �it kj A ter ` I, or the furnace heat �exchange� a refFigerant c , ge measure ent sh verified per § 2(b) IF. • Central Fan Inte rated(CFI)�Ve tilati t iii ,g o � "0TV N i ton. LD ventilation re u'irements o� f §l�.�o(o).d`o nota I to existing residential homes. ted Split Sys ems -Air Conditioners and Meat P'1i mps Airflow �'HFR'� rifrca7iio'r , required for this measure. ES 0 NO YES: _n Clim to-Zo n 10 through 15, when the e xstigg space-condlt" n cyst (HVAC equipment and ducting) is 1 replaced; the air ow an fan it draw shallAse verified per § (52(b)l meett the'reiluiremenis of § 15l(f)7B. -I*_` _f I k I t I . 1 r N Documentation Author's Declaration Stateme`fn • 1 certify that this Certificate of Com1plianci do.cumcntation is accurate andNZ_ _lcte. Name: Ruth Debrick Signature: Ruth Debrick Company: Venvest Ballard/One Hour Air Dom' 1/30/2013 Address: 3030 Myers St,Street if Applicable (]CEA or ❑CEPE (Certification #): City/State/Zip: Riverside California 92503 Phone: 951-276-9744 Responsible Building Designer's Declaration Statement • I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the building design identified on this Certificate of Compliance. • i certify that the energy features and performance specifications for the building 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 building design features identified on this Certificate of Compliance are consistent with the information provided to document this building design on the other applicable compliance forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application. Name: Signature: Company: p Y Date: 1/30/2013 Address: License: 878533 City/State/Zip: Phone: Por assistance or questions regarding the Energy Standards, contact the Energy Hotline at. 1-800-772-3300. Registration Number: 313-A0014222A-000000000-0000 Registration Date/Time: 01/30/201311:08:47 HERSProvider: CBPCA 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-04 Space Conditioning Systems, Ducts and Fans (Page 1 of 2) Site Address: Enforcement Agency:T11 rmit Number: 54733 Systeml Inverness Way La Quinta CA 92253 La Quinta, City of 426 Space Conditioning Systems Heating Equipment Equip Type (package heat pump)and CEC Certified Mfr. lame Model Number A Reference Numbgr1 # of Ide.flcal Systems Duct Duc Oc+ati-� (attic, 'space � etss ,r' uct R-val Coo ing Load (Btu�hr) Cooling Capacity Btu/hr AirConditioner ---- Goodman GSX130421 Efficiency Location -- 1 13 Home( Equip 28006 42000 (AFUE, (attic, -J Type ARI # of etc.)" I crawl- Heating Heating (package- CEC Certified Mfr. Name Reference Identical (>_CF -IR space, Duct Load Capacity heat um and Model Number Number 2 Systems value 4 etc.) R -value Btu/hr Btu/hr Furnace Goodman GMS80604AX 1 80 Home 48000 60000 e I : pow w Cooling Equ ipmen� _ + - j 421 KPI - Equip Type (package heat pump)and CEC Certified Mfr. lame Model Number A Reference Numbgr1 # of Ide.flcal Systems Effictenc (SE and E R) (>CF 1 V41u: e)4`' Duc Oc+ati-� (attic, 'space � etss ,r' uct R-val Coo ing Load (Btu�hr) Cooling Capacity Btu/hr AirConditioner ---- Goodman GSX130421 -- 1 13 Home( 28006 42000 -J /. /f project is new construction, see Footnotes to Standards Table 151-B and Table 15/-C for duct ceiling alternative compliance. 2. ARI Reference Number can be found by entering the equipment model number at http://iviviv.aridirectory. org/ari/ac.php# 3. Listed efficiency on this page must be greater than or equal (>) to the value shown on the CF -1 R form. 4. When CF -/R is reference it is also applicable to the CF -/R, CF -IR -AA or CF -IR -ALT ALL BOXES MUST BE CHECKED TO BE A,VALID FORM ID § 110-§ 113: HVAC equipment is certified by the California Energy Commission. ❑✓ §150(h): Heating and/or cooling loads calculated in accordance with ASHRAE, SN ACNA, or ACCA. ❑✓ §150(i): Setback Thermostat on all applicable heating and/or cooling systems meet the requirements of §112(c). ❑✓ §1500)2: Pipe insulation for cooling 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. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-04 Space Conditioning Systems, Ducts and Fans (Page 2 of 2) Site Address: Enforcement Agency: Permit Number: 54733 Systeml Inverness Way La Quinta CA 92253 La Quinta, City of 12-1426 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 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 ❑✓ 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. 0✓ 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. R1 8. Gravity ventilating systems serving operate fi f o 11 n i +� 114 , ❑✓ 9. Protection=of I sullati a"Ins la ' equipment maintenance, andvind. i C4 water retiardantfal do prpvides hieldi g fron I✓ 10� Flexible ducts cannot have porous 0 ed space have either automatic or readily accessible, manually t� orgo e roted from damag including that clue to sunlight, moisture, u>rot� �„"+� _ r oating that is iation that can cause degradation of the material. e 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-IR)form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF -IR 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. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) Venvest Ballard/One Hour Air Responsible Person's Name: Responsible Person's Signature: Ruth Debrick Ruth Debrick CSLB License: Date Signed: Position With Company (Title): 878533 1/30/2013 owner 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-04 Space Conditioning Systems, Ducts and Fans Page 1 of 2 Site Address: Enforcement Agency: Permit Number: 54733 System2 Inverness Way La Quinta CA 92253 La Quinta, City of 12-1426 Space Conditioning Systems Heating Equipment Equip Type (package heat um) _ CEC Certified Mfr. and Model Number lam 'I Reference �Number'a Duct E f iienc (E' and I R) (? Ff �' lue) t;. �aoc�afi (attic, .�� pace et / r f D_.uct-, R -valuer Coo ing Lod Btuthr Cooling Capacity Btu/hr Efficiency Location Equip 13 --- Homer (AFUE, (attic, 42000 Type ARI # of etc.)" crawl- Heating Heating (package- CEC Certified Mfr. Name Reference Identical (>_CF -I R space, Duct Load Capacity heat um and Model Number Number 2 Systems value 4 etc.) R -value Btu/hr Btu/hr Furnace Amana AMH80604BX 1 80 Home 48000 60000 . tl M PIP& pk Cooling Eq ipmenr�'1 r � Equip Type (package heat um) _ CEC Certified Mfr. and Model Number lam 'I Reference �Number'a # of Id .;tical Systems E f iienc (E' and I R) (? Ff �' lue) t;. �aoc�afi (attic, .�� pace et / r f D_.uct-, R -valuer Coo ing Lod Btuthr Cooling Capacity Btu/hr AirConditioner Goodman GSX130421 1 13 --- Homer 280 0 42000 J i. q project is new construction, see 1, ootnotes to Standards Table 151-B and Table 151-C for duct ceiling alternative compliance. 2. ARI Reference Number can be found by entering the equipment model number at http://rvlviv. aridirectory. org/ari/ac.php# 3. Listed efficiency on this page must be greater than or equal (>) to the value shown on the CF -1 R form. 4. When CF -IR is reference it is also applicable to the CF -IRI CF -JR -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 §112(c). IZI §1500)2: Pipe.insulation for cooling 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. 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-04 Space Conditioning Systems, Ducts and Fans (Page 2 of 2 Site Address: Enforcement Agency: Permit Number: 54733 System2 Inverness Way La Quinta CA 92253 La Quinta, City of 12-1426 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 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 ❑✓ 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. 0 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. ID 7. Exhaust fan systems have back draft or automatic dampers. 0 8. Gravity ventilating systems serving conditioned space have either automatic or readily accessible, manually operate �,�ii611"foli ��INC '�ildinP'rforO47Y' ❑✓ 9. Pro tion=of==I.n�ulati kmUns la shall be prote d om damag including that c1pe to Sunlight, moisture, equipmep�t maintenance, and wind. r eUa V`u i otA & i oating that is water r efardantf din prov.idel . hieldi g from solar radiation that can cause degradation of the material. ❑✓ 10 Flexible ducts cannot have porous inn r cores. n DECLARATION STATEMENT • 1 certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. • 1 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 -1 R) form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF -1 R 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. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) Venvest Ballard/One Hour Air Responsible Person's Name: Responsible Person's Signature: Ruth Debrick Ruth Debrick CSLB License: Date Signed: Position With Company (Title): 878533 1/30/2013 owner 2008 Residential Compliance Forms August 2009 CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF-4R-MECH-21 Duct Leakage Test - Existing Duct System Pae 1 of 2) Site Address: Enforcement Agency: Permit Number: 54733 Systeml Inverness Way La Quinta CA 92253 La Quinta, City of 12-1426 Enter the Duct System Name or Identification/Tag: Enter the Duct System Location or Area Served: Home 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, plentims, 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 Diaannstic Tect — eYistina durt evctrm Select one compliance method from the following four choices. 17 Option Measured leakage less than 15% of Fan Airflow. ��1. aft ❑ Option tlhl���yp "`ltii' rib P 1d i A "�!iif+'irf ® i YI ❑ Opti 3. Reduce leaks e I 0% o In c p g Y ° re d i li alG it �4�' et 1h o ❑ Option 4�Fix all acces ilili�aks usi cske�st; and I .sl ,I;R-S-rater rnot.Ver-ilfi mus�tbettempt �lizing Note: (Optioon 1 d before�u Optioin A/ Determine nominal, Fan�Airflo usingne o the following thr�"e calcula on methods. ❑ Cooling system method: Size of con ens r in Tons 3A 400 1a 0.00 FM ❑ Heating system method: 21.7 x— N (Heating Out„put�Capa kBtuh' —`CFM ❑ Measured system airflow using RA3.3 airflow tist CFM, projedures: �� Option 1 used then: ,�- Allowed leakage = Fan Airflow 1400.00 x 0.15 = 210.00 CFM I Actual leakage= 95.00 CFM Pass if Actual leakage is less than Allowed leakage 17 Pass ❑ Fail Option 2 used then: Allowed leakage = Fan Airflow x 0.10 = CFM 2 Actual leakage to outside = CFM Pass if Actual leakage to outside is less than Allowed leakage ❑ Pass ❑ Fail Option 3 used then: Initial leakage prior to start of work= CFM Final leakage after sealing all accessible leaks using smoke test = CFM 3 Initial leakage - Final leakage = Leakage reduction CFM (Leakage reduction / Initial leakage ) x 100% = % Reduction Pass if % Reduction > 60% ❑ Pass ❑ Fail Option 4 used then: All accessible leaks repaired using smoke test. HERS rater must verify (No sampling). 4 Pass if all accessible leaks have been sealed using Smoke Test ❑ Pass ❑ Fail Registration Number: 313-A0014220A-M2114230A-M21A Registration Date/Time: 01/30/2013 11:23:40 HERSProvider.- CePCA 2008 Residential Compliance Forms August 2009 CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF-4R-MECH-21 Duct Leakage Test — Existing Duct System Pae 2 of 2) Site Address: Enforcement Agency: Permit Number: 54733 System1 Inverness Way La Quinta CA 92253 La Quinta, City of 12-1426 ❑+ Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off during duct leakage testi gti ��Oq uc t tili t �!t%zc� 'da e s ey e O entilation is required to meet ASHRapa�adfcse�Jn y dthe closed position during duct lea age'testng'".`�''� --- ksoe. ■ 121All supply and return register boots Con, i_ I eat s k i i applies to duct leakagte'tcompli` ce options (leakag ed"tction by 60% aild option 4 fix all accessible leaks) described above. � New duet insta lations cannot utilize building cavities as plenums �M}latform,r=esi in lieu of ducts. 0 Mastic and draw ba mus f a use in co nbination w th cl th backed rubber ve-duc''ap tb seal leaks at all new duct connections: F kc t DECLARATION STATEMENT t� • I certify under penalty of perju , y u-A—AheI_ aw�s.of'ihe Stat=ofsC IifGrn"N a in ornia Rrovide onIlits form s true and correct. • I am the certified HERS rater who performed the verification services identified and reported on thits ceftificate (�sponsible rater). • The installed feature, material, component, or manufac ured 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 -I R) 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 -1 R) approved by the enforcement agency. Builder or Installer information as shown on the Installation Certificate CF -6R Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) Venvest Ballard/One Hour Air Responsible Person's Name: CSLB License: Ruth Debrick 878533 HERS Provider Data Registry Information Sample Group # (if applicable): ❑O tested/verified dwelling ❑ not-tested/verified dwelling 313-0024 in a HERS sample group HERS Rater Information HERS Rater Company Name: Athens Air Inc. Responsible Rater's Name Responsible Rater's Signature Andrew Pulos Andrew Pulos Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 1095886 1/30/2013 Registration Number: 313-A0014220A-M2114230A-M21A Registration Date/Time: 01/30/201311:23:40 HERS Provider: CBPCA 2008 Residential Compliance Forms August 2009 CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF-4R-MECH-21 Duct Leakage Test — Existing Duct System (Page 1 of 2) Site Address: Enforcement Agency: Permit Number: 54733 System2 Inverness Way La Quinta CA 92253 La Quinta, City of 12-1426 Enter the Duct System Name or Identification/Tag: Enter the Duct System Location or Area Served: Home 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 Leakape. Dinonnstic Test — existina duet cvctPm Select one compliance method from the following four choices. ❑ Option 1. Measured leakage less than 15% of Fan Airflow. ❑ Option /� `7�' [3-- t6�'(�l i?' �.i lott Rk ❑ Option 3. R duceby 0% o re u � ea n(Isar on ;1i- 1 ❑ V '�� 3 Option 4. Fix all acces able leaks usi srr�ke�st, and, 1H&RS rater nst r.f must Note: (Opti�On 1 be attemp-1 d befoutilizing Option 4) �:.'y F Determine nominal Fan lousing) neo the following thr to caicular on methods_ of cond'ens r in Tons 400 ❑ Cooling system method: Siz17x___f*"__ ❑ Heating system method: 2114ating Output uh .CFM ❑ Measured system airflow using RA3.3 airflow t st proedures: CFM,, Option 1 used then: -----' Allowed leakage = Fan Airflow x 0.15 = CFM 1 Actual leakage = CFM Pass if Actual leakage is less than Allowed leakage ❑ Pass ❑ Fail Option 2 used then: Allowed leakage = Fan Airflow x 0.10 = CFM 2 Actual leakage to outside = CFM Pass if Actual leakage to outside is less than Allowed leakage ❑ Pass ❑ Fail Option 3 used then: Initial leakage prior to start of work= CFM Final leakage after sealing all accessible leaks using smoke test = CFM 3 Initial leakage - Final leakage = Leakage reduction CFM (Leakage reduction / Initial leakage ) x 100% = % Reduction Pass if % Reduction > 60% ❑ Pass ❑ Fail Option 4 used then: All accessible leaks repaired using smoke test. HERS rater must verify (No sampling). 4 Pass if all accessible leaks have been sealed using Smoke Test ❑ Pass ❑ Fail Registration Number: 313-A0014222A-M2114233A-M21A Registration Dale/Time: 01/30/201311:23:40 HERS Provider: CBPCA 2008 Residential Compliance Forms August 2009 CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF-4R-MECH-21 Duct Leakage Test — Existing Duct System (Page 2 of 2 Site Address: Enforcement Agency: Permit Number: 54733 System2 Inverness Way La Quinta CA 92253 La Quinta, City of 12-1426 ❑ Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off during duct leakage test' g,, O uc t tili t to'2, dame s, t e e O entilation is required to meet ASHRjj' t a se�tl�t,r��irii tj t}ie closed position during duct leakage testing~.� ❑ All supply<nd return register boots t t b t l 'i s ok q j l applies to duct leakage comp'�ance options (leakuge� ction by 60% agd option 4 fix all accessible leaks) described above. ❑ New duct installations cannol utilizebuildingcavities as plenums �zpl'af>oiin retro, s in lieu of ducts. ❑ Mastic and draw bands must e used] i" ne4nbination w th cl th bacldCua�f,v*duct tape foseal leaks at all new duct connections,.--------" It I DECLARATION STATEMENT �"/ �� `ic • I certify under penalty of pe , undeth law he State o Califom'ia, he mformat Rrovideorrth`s form s true and correct. • I am the certified HERS rater who performed the veLficaticIn services identified and reported on this cce0ficate ( sponsible rater). • The installed feature, material, component, or manulactue-0 device requiring HERS verification this identi edEQn 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 -1 R) 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 -1 R) approved by the enforcement agency. Builder or Installer information as shown on the Installation Certificate CF -6R Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) Venvest Ballard/One Hour Air Responsible Person's Name: CSLB License: Ruth Debrick 1878533 HERS Provider Data Registry Information Sample Group # (if applicable): ❑ tested/verified dwelling 0 not-tested/verified dwelling 313-0024 in a HERS sample group HERS Rater Information HERS Rater Company Name: Athens Air Inc. Responsible Rater's Name Responsible Rater's Signature Andrew Pulos Andrew Pulos Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 1095886 1/30/2013 Registration Number: 313-A0014222A-M2114233A-M21A Registration Date/Time: 01/30/201311:23:40 HERSProvider: CBPCA 2008 Residential Compliance Forms August 2009 CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF-4R-MECH-25 Refrigerant Charge Verification - Standard MeasOrement Procedure Pae 1 of 5) Site Address: Enforcement Agency: Permit Number: 54733 Systeml Inverness Way La Quinta CA 92253 La Quinta, City of 12-1426 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 RA 3.2. 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 lGoodman System Location or Area Served (Home 1 IZZWes IMP IIIR 2 OYe Yes to 1 and is a 0 5/16 inch (8 mm) access hole upstream of evaporative coil in the return plenum and QTMC' - Canenr nn 46a G'aronnr.,4nr f'�.:1 oil7 :the supply plenum or Fail I V - El Pass '� ✓ ❑ Fail System Nam a Iden i atin/Tg Goodman Goodman 3 Dyes ❑No Therse sor is factory ins_tabled, or fel nsta a acc�ordin to ma'nufact lrer's sp��i'fic_attiioon,.s+ or is in talled by 1 eth `od . peci i ¢ Cl s aped by tj�e Executive � 1. 6 Dyes ❑No The sensor wide is terminated with a standard mini .plug suitable for colnnection to a 4 Dyes ❑No digital thermos ieten4rhe sensor mini plug is access lblesto=the tat -lin technician and the HERS rater without changing the airflow through the condenser coil . 5 Dyes ❑No 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 ✓ p N/A ✓ ❑ Pass ✓ ❑ Fail STMS - Sensor on the Condenser Cail System Name or Identification/Tag Goodman The sensor is factory installed, or field installed according to manufacturer's 6 Dyes ❑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 Dyes ❑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 Dyes ❑No The 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 applicable. Otherwise enter Pass or Fail ✓ El N/A ✓ ❑ Pass ✓ ❑ Fail Registration Number: 313-AO01422OA-M2514231A-M25A Registration Date/Time: 01/30/2013 11:22:19 HERS Provider: cePCA 2008 Residential Compliance Forms August 2009 CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5) Site Address: Enforcement Agency: Permit Number: 54733 Systeml Inverness Way La Quinta CA 92253 La Quinta, City of 12-1426 Standard Charge Measurement Procedure (for use if outdoor air dry-bulb is above 55 °F) Procedures for determining Refrigerant Charge using the Standard Charge Measurement Procedure are available in Reference Residential Appendix RA3.2. As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional forms) for any additional systems in the dwelling as applicable. • The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure. • The system must meet minimum airflow requirements as prerequisite for a valid refrigerant charge test. . • If outdoor air dry-bulb is 55 OF or below, the installer must use the Alternate Charge Measurement Procedure. Snace Canditinninu Svctemc System Name or Identification/Tag Goodman �Gauge.alation -7 ! System Location or Area Served Home 1 /2013 'r. Outdoor Unit Serial # 1206456963 Outdoor Unit Make Goodman Outdoor Unit Model GSX130421 Nominal Co '. g C laaoity Btu/hr• 420W ,0 nor11 Date of Verification =- 1/4/2013 �� 4ft ■ ■ ah dft Aft'n ift Rol, Calibration'nf Diaunnsticrin.ctrtimentt-- Date of Refrigerant ,; 1/2/2013(must �Gauge.alation -7 ! be re -calibrated monthly) r Date of Thermocouple Ca bca o L 1 /2013 'r. 1 must bre rre. alibrrated monthly) 49.00 Return (evaporator entering) air dry-bulb Measured Temneratures (°Fl tt si System Name or Identification/Tag Goodman� ! Supply (evaporator leaving) air dry-bulb L 'r. temperature (Tsu 1 , db) 49.00 Return (evaporator entering) air dry-bulb temperature (Tretum, db) 73.00 Return (evaporator entering) air wet -bulb temperature (Tretum, wb) 53.00 Evaporator saturation temperature ( Teva orator sat) 32.00 Condensor saturation temperature (Tcondensor, sat) 87.00 Suction line temperature (Tsuction) 43.00 Liquid Line Temperature (Tliquid) 76.00 Condenser (entering) air dry-bulb temperature (Tcondenser, db) 70.00 Registration Number: 313-AO01422OA-M2514231A-M25A 2008 Residential Compliance Forms Registration Date/Time: 01/30/201311:22:19 HERS Provider: eePCA August 2009 CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5) Site Address: Enforcement Agency:712-1426 ermit Number: 54733 Systeml Inverness Way La Quinta CA 92253 La Quinta, City of 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 Goodman Calculate: Actual Temperature Split = 24.00 Tretum, db - Tsupply, db Target Temperature Split from Table RA3.2-3 using Tretum, wb and Tretum, db 22.00 Calculate difference: Actual Temperature 2.00 Split — Target Temperature Split = Passes if difference is between -4°F and +4°F oruporijerne surreent if bitwee -4°F and -1 � 0 l.' li'�i�iefYlpm Bu Past r amI Feil for Note: Temp ern.tureSplit thod airflow mea¢enren pro�ced� Cct(cu ajs. f (i rJ r r +one of the specifi c! eee�i !R�n'kr p� if�tcrIQa�rflow is measured, the vahOe' mast be egu ,l to or yezitenthc�nAGh�Ca�lorrla2e Min' p yr�nz9 ow Requirement in the table below. Calculatl�Vlinim edm Airflowequir men (CFM) _ ominalCoolmg'`ap cttton300.(cfm/ton) System Name or Identification/T g , oodman �o ,sem Calculated Minimum Airflow Requirement (CFM) Measured Airflow using RA3.3 procedures (CFM) Passes if measured airflow is greater than or equal to the calculated minimum airflow requirement. Enter Pass or Fail Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for fixed orifice metering device systems System Name or Identification/Tag Goodman Calculate: Actual Superheat = Tsuction — Teva orator sat Target Superheat from Table RA3.2-2 using Tretum 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 Registration Number: 313-AOOI4220A-M2514231A-M25A 2008 Residential Compliance Forms Registration Date/Time: 01/30/201311:22:19 HERS Provider: caPCA August 2009 CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5) Site Address: Enforcement Agency: Permit Number: 54733 Systeml Inverness Way La Quinta CA 92253 La Quinta, City of 12-1426 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 Goodman onnance Calculate: Actual Subcooling = p+ �I t ' , *` t'�L���li s t." Tcondenser, sat — Tli uid 11.00 ® Target Subcooling specified by f_ Enter allowable sup'erheaY range rorn — manufacturer 10.00 manufacturer's specifications (orse range " 1 between 3° and 26�'ifs an`ufacturer's '5 3.00-26.00 Calculate difference: specification not available) Actual Subcooling — Target Subcooling = 1.00 System passes if aetua"uperhea is within t System passes if difference is between the allowable superheat range ass .. r -4oF and +4°F Enter Pass or Fail pass Enter Pa s or- FiaiL_ 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 Na r d i a qLAI onnance -- Calculate: Actua-I•Superheat — - p+ �I t ' , *` t'�L���li s t." Tsuction — Tev-a orator sat_ ® Ir,�r j f_ Enter allowable sup'erheaY range rorn — manufacturer's specifications (orse range " 1 between 3° and 26�'ifs an`ufacturer's '5 3.00-26.00 specification not available) System passes if aetua"uperhea is within t the allowable superheat range ass .. r Enter Pa s or- FiaiL_ Registration Number: 313-AOO 1 4220A -M2514231 A-M25A 2008 Residential Compliance Forms Registration Date/Time: 01/30/201311:22:19 HERS Provider: c9PCA August 2009 CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5) Site Address: Enforcement Agency: Permit Number: 54733 System1 Inverness Way La Quinta CA 92253 La Quinta, City of 12-1426 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 Goodman 878533 HERS Provider Data Registry Information Sample Group # (if applicable): System meets all refrigerant charge and Pass 313-0024 in a HERS sample group airflow requirements. Enter Pass or Fail HERS Rater Company Name: Athens Air Inc. Responsible Rater's Name Responsible Rater's Signature Ii ornia[ uild Performance - r� R`%dolts cr u 0 DECLARATION STATEMENT • I certify under penalty of perjuryunder he 1, a�ws ofit ie State f�Calif�ornt h infor 1 idi`` rot ided on.this form is true and correct. • 1 am the certified HERS rater who performed the ver1ficatio ser" vices identified and reportedn thisiti 'date (responsible rater). • The installed feature, material, component, or manuf ctured device requiring HERS verificatio �. tthat is identified on this certificate (the installation) complies with the applicable requirements in Reference Residential Appendice'2 and RA3 and the requirements specified on the Certificate(s) of Compliance (CF -1 R) 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 -1 R) approved by the enforcement agency. Builder or Installer information as shown on the Installation Certificate CF-611 Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) Venvest Ballard/One Hour Air Responsible Person's Name: CSLB License: Ruth Debrick 878533 HERS Provider Data Registry Information Sample Group # (if applicable): m tested/verified dwelling ❑ not-tested/verified dwelling 313-0024 in a HERS sample group HERS Rater Information HERS Rater Company Name: Athens Air Inc. Responsible Rater's Name Responsible Rater's Signature Andrew Pulos Andrew Pulos Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 1095886 1/30/2013 Registration Number: 313-AOO 1 4220A -M2514231 A-M25A 2008 Residential Compliance Forms Registration Date/Time: 01/30/201311:22:19 HERS Provider CBPCA AtrgtrSt LUUY CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF-4R-MECH-25 Refrigerant Charge Verification - Standard Meas6rement Procedure (Pae 1 of 5 Site Address: Enforcement Agency: Permit Number: 54733 System2 Inverness Way La Quinta CA 92253 La Quinta, City of 12-1426 Note: If installation of a Charge Indicator Display (CID) is utilized as an alternative to refrigerant charge verif cation 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 forms) 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 RA 3.2. If refrigerant charge verification is required for compliance, TMAH are also required for compliance. STMS are only required for completely new or replacement space -conditioning systems that utilize prescriptive compliance method. TMAH - Access Holes in Supply and Return Plenums of Air Handler System Name or Identification/Tag System Location or Area Served 5/16 inch (8 mm) access hole upstream of evaporative coil in the return plenum and 1 13 es �-, ❑No Il a '� a - IF, 94j#Ve tV 2 ❑Y 0 o _ 1 me mm o e a ce do tr am f e agora iv �coi ahe supply plenum a d paqjtV,irA ct'; +� ation - - Yes to 1 anrdr2 is aypass. I V1�� Enter Pass or Fail ✓ ❑ Pass ✓ ❑Fail ,.TMC - CPncnr nn thn Fvannratnr Vii -� _ � System Name Identif do ��g ,,or '� The sensor is factory installed, or field installed according to manufacturer's 6 ❑Yes The\em& is factory Nstalled, or fi'nsta e a rding to manufacturer's • 3 ❑Yes ❑No �s sty spie �if]i] ions or is in talled by i eTt l d ' Sp ci %�s aped by the Executive Director. —Direec mmr P ! The sensor wire is terminated with a standard mini plug suitable for connection to a 7 ❑Yes The sensor wire is terminated with a standard mini lug suitable for connection to a 4 ❑Yes ❑No digital thermometer--4i'he sensor mini plug is access ible=to.the- nstalling technician and the HERS rater without changing the airflow through the condenser coil 8 ❑Yes the HERS rater without changing the airflow through the condenser coil 5 ❑Yes ❑No 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 ✓ []Pass ✓ []Fail STMS - Sensor on the Condenser Coil System Name or Identification/Tag The sensor is factory installed, or field installed according to manufacturer's 6 ❑Yes ❑No specifications, or is installed by methods/specifications approved by the Executive Director. The sensor wire is terminated with a standard mini plug suitable for connection to a 7 ❑Yes ❑No digital thermometer. The sensor mini plug is accessible to the installing technician and the HERS rater without changing the airflow through the condenser coil 8 ❑Yes ❑No The 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 ✓ ❑ Pass ✓ []Fail N/A if STMS are not applicable. Otherwise enter Pass or Fail Registration Number: 313-AOO I 4222A-M2514234A-M25A 2008 Residential Compliance Forms Registration Date/Time: 01/30/201311:22:19 HERS provider.. caPcA August 2009 CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5) Site Address: Enforcement Agency:712-1426 ermit Number: 54733 System2 Inverness Way La Quinta CA 92253 La Quinta, City of 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. • /f outdoor air dry-bulb is 55 IF or below, the installer must use the Alternate Charge Measurement Procedure. Snace Conditioninv Svstems System Name or Identification/Tag � _ (must be re -calibrated monthly) Date of Thermocoupl„ `e C(Ol System Location or Area Served Supply (evaporator leaving) air dry-bulb Outdoor Unit Serial # temperature (Tsu 1 , db) Outdoor Unit Make Return (evaporator entering) air dry-bulb Outdoor Unit Model temperature (Tretum, db) Nominal Coig C }�aoity Btu/hr,• ., - • Return (evaporator entering) air wet -bulb Mj *All 1%4 lif %olli �.__ ance _.ilia Date ofVerifica�f�to-n Evaporator saturation temperature �' (Teva orator, sat) Calihration"rof DiaenosAc=lnstrhmenA, Date of Re rigerantt Gauge—Cali � _ (must be re -calibrated monthly) Date of Thermocoupl„ `e C(Ol must bye re -calibrated monthly) Measured Temperatures (IF) N In r System Name or Identification/Tag Supply (evaporator leaving) air dry-bulb temperature (Tsu 1 , db) Return (evaporator entering) air dry-bulb temperature (Tretum, db) Return (evaporator entering) air wet -bulb temperature (Tretum, wb) Evaporator saturation temperature (Teva orator, sat) Condensor saturation temperature (Tcondensor, sat) Suction line temperature (Tsuction) Liquid Line Temperature (Tliquid) Condenser (entering) air dry-bulb temperature (Tcondenser, db) Registration !Number: 313-AO014222A-M2514234A-M25A 2008 Residential Compliance Forms Registration Date/Time: 01/30/2013 11:22:19 HERS Provider: CBPCA August 2009 CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF-4R-MECH-25 Refrigerant Charge Verification - Standard Meastirement Procedure (Page 3 of 5) Site Address: Enforcement Agency: Permit Number: 54733 System2 Inverness Way La Quinta CA 92253 La Quinta, City of 12-1426 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 = Tretum, db - Tsupply, db Target Temperature Split from Table RA3.2-3 using Tretum, wb and Tretum, db Calculate difference: Actual Temperature Split - Target Temperature Split = Passes if difference is between -4°F and +4°F or upo emeasuure en�t*pif between -4°F and -1 lite m f � i L'd in I 'iV i Banca Note: Temperat.a e Split Metho Calcu airflow meas,��tu ernent procedures pecifi�' a j s l (i yl r e r n one of the �ee9�Ae!Rii�*ntrpi�tIflow is measured, t ae valve must - g 1 to orpremr-thain=the=C larrla2e Mini •una lir ow Requirement in the table below. rr Calculatedl nilm Airflow �equir men (CFM) = J omi al Cooling ap skN= on) X-3_00 (c ton) System Name or Identification/T g Calculated Minimum Airflow Requirement (CFM) Measured Airflow using RA3.3 procedures (CFM) Passes if measured airflow is greater than or equal to the calculated minimum airflow requirement. Enter Pass or Fail Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for fixed orifice metering device systems System Name or Identification/Tag Calculate: Actual Superheat = Tsuction - Teva orator sat Target Superheat from Table RA3.2-2 using Tretum, 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 Registration Number: 313-AOO14222A-M2514234A-M25A 2008 Residential Compliance Forms Registration Date/Time: 01/30/201311:22:19 HERSProvider: cBFCA Aargust 2009 CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measitremei t Procedure (Page 4 of 5 Site Address: Enforcement Agency:712-1426 ermit Number: 54733 System2 Inverness Way La Quinta CA 92253 La Quinta, City of 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 c Calculate: Actual Subcooling = Q` `'` Tcondenser, sat — Tli uid Tsuction —Teva orator.—sat iL� 4�' Target Subcooling specified by Enter allowable superhealt range rom - manufacturer manufacturer's specifications (or use range between 3° and 26- f n fa' • turer's t Calculate difference: specification '� not available) / Actual Subcooling — Target Subcooling = System passes flf-actualzupArheal is wit in System passes if difference is between the allowable superheat range -4°F and +4°F Enter Pass or Fail Enter Pass or flak_ 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 Nar$ d' i • a cii c Calculate: Actual -Superheat = -- — Q` `'` Tsuction —Teva orator.—sat iL� 4�' +, }i+'' ". Enter allowable superhealt range rom - manufacturer's specifications (or use range between 3° and 26- f n fa' • turer's t specification '� not available) / .� System passes flf-actualzupArheal is wit in the allowable superheat range Enter Pass or flak_ Registration (Number: 313-A0014222A-M2514234A-M25A 2008 Residential Compliance Forms Registration Date/Time: 01/30/201311:22:19 HERS Provider: cBFCA August 2009 CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure Pae 5 of 5) Site Address: I Enforcement Agency: Permit Number: 54733 System2 Inverness Way La Quinta CA 92253 La Quinta, City of 12-1426 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 Ruth Debrick 878533 HERS Provider Data Registry Information Sample Group # (if applicable): System meets all refrigerant charge and m not-tested/verified dwelling 313-0024 in a HERS sample group airflow requirements. - Enter Pass or Fail HERS Rater Company Name: Athens Air Inc. Responsible Rater's Name Responsible Rater's Signature Build - n rmance F�l Conto Odors Associatid 0 Yds . f� DECLARATION STATEMENT' - • I certify under penalty of perjuryunder he laws olie Stalof CCalifomi'a& h 'infonii tial ro ,(ided on_this �form is true and correct. • I am the certified HERS rater who performed the venicatio n services identified and report ed�on this cert _care (responsible rater). • The installed feature, material, component, or manuf ctured device requiring HERS verificatio that is identified on this certificate (the installation) complies with the applicable requirements in Reference Residential Appendices RAS and RA3 and the requirements specified on the Certificate(s) of Compliance (CF -1 R) 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 -1 R) approved by the enforcement agency. Builder or Installer information as shown on the Installation Certificate CF -6R Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) Venvest Ballard/One Hour Air Responsible Person's Name: CSLB License: Ruth Debrick 878533 HERS Provider Data Registry Information Sample Group # (if applicable): ❑ tested/verified dwelling m not-tested/verified dwelling 313-0024 in a HERS sample group HERS Rater Information HERS Rater Company Name: Athens Air Inc. Responsible Rater's Name Responsible Rater's Signature Andrew Pulos Andrew Pulos Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 1095886 1/30/2013 Registration Number: 313-AO014222A-M2514234A-M25A 2008 Residential Compliance Forms Registration Date/Time: 01/30/201311:22:19 HERS Provider: CBPCA August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS Duct Leakage Test — Existing Duct System Pae 1 of 2 Site Address: Enforcement Agency: Permit Number: 54733 System1 Inverness Way La Quinta CA 92253 La Quinta, City of T12-1426 Enter the Duct System Name or Identification/Tag: Enter the Duct System Location or Area Served: Home 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 existingparts 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 Lenkaae ninannctir Tnct — F.viefina Mirt C.retnrn Select one compliance method from the following four choices. El Option 1. Measured leakage 15% of Fan Airflow. }+less -_than p p� ElOption 2 asi gletp �1d -• , ' IA i1 i o9 mance ❑Option 3. Reduce''leak�ag by' 0% or r 1I if i o a ei 0 n ❑ Option 4 Fix all acces ible�le ks usiU..grn�lee�est; and., P�E-RSsrate� r mist vciri Note: Ism (Opt on 1 e attempted before.ut lizing Option 4)-,.' Determine nom naliFawn Airflo using neo the following thrJe calcula t on methods. rFIGI El Cooling system method: Siz of con ans r in Tons 3 S Xx 400 = 14 ° ❑ Heating system method: 21.7 . e,Neatin ©ut ut G 'abi kBtuh � ^"CFM g 4 — ❑ Measured system airflow using RA3.3 airflow tf st prordures: CFM, `+--•�' Option 1 used then: Allowed leakage = Fan Airflow 1400 x 0.15 = 210 CFM 1 Actual leakage= 130 CFM Pass if Actual leakage is less than Allowed leakage El Pass ElFail Option 2 used then: Allowed leakage = Fan Airflow X0.10= CFM 2 Actual leakage to outside = CFM Pass if Actual leakage to outside is less than Allowed leakage [IPass ElFail Option 3 used then: Initial leakage prior to start of work= CFM Final leakage after sealing all accessible leaks using smoke test = CFM 3 Initial leakage - Final leakage = Leakage reduction CFM (Leakage reduction / Initial leakage ) x 100% = % Reduction Pass if % Reduction > 60% ❑Pass ❑Fail Option 4 used then: 4 All accessible leaks repaired using smoke test. HERS rater must verify (No sampling). Pass if all accessible leaks have been sealed using Smoke Test ❑Pass ❑Fail Registration Number: 313-A0014220A-M2114230A-0000 2008 Residential Compliance Forms Registration Date/Time: 01/30/2013 11:01:17 HERS Provider: CBPCA August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS Duct Leakage Test — Existing Duct System (Page 2 of 2) Site Address: I Enforcement Agency: Permit Number: 54733 System1 Inverness Way La Quinta CA 92253 La Quinta, City of 12-1426 0 Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off during duct leakage testing. CFI OA ducts that utilize controlled motorized dampers, that open only when OA ventilation is required to meet ASHRAE Standard 62.2, and close when OA ventilation is not required, may be configured to the closed position during duct leakage testing. El All sup a s .~ Id �' d" liance — applies to duct leakage ounce o iron leakAg6e ciilm mid"optiioon 4f fiz a siEil"e 1ea�Cs described above. 121 New duct in' stallations can3o utiliz b7-400,,arf 00 atfp"r� tt i i wn D Mastic alit, d draw band must e used *,n' ombtirkafion-v0h*c1-bac�Cl d iu—'GGe-m - esive duct tape to seal leaks at all new duct connections. DECLARATION -STATE _ M,ENT • I certify under penalty of perjury under th laws of the State of Gar mia th8: o ion pr- vid'ed o form is true and correct. • I am eligible under Division 3 o the Bu i sss and rofessio s Code to act t �espons14— for co�tion, or an authorized nk 41'1Z ...` representative of the person responsible for cons ruction (res ons'151 person). — • 1 certify that the installed features, materials, compo q'ents, or manufactured devices identified 0n this cceer iffiicate (th k installation) conforms to all applicable codes and regulations, and the -installation is consistent with the plan a`and�apecrfications-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 -I R) form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF -I R 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) Venvest Ballard/One Hour Air Responsible Person's Name: Responsible Person's Signature: Ruth Debrick Ruth Debrick CSLB License: Date Signed: Position With Company (Title): 878533 11/30/2013 Is this installation monitored by a Third Party Quality Control Name of TPQCP (if applicable): Program (TPQCP)? ❑Yes . ONo Registration Nwnber: 313-A0014220A-M2114230A-0000 Registration Date/Time: 01/30/2013 11:01:17 HERS Provider: CBPCA 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS Duct Leakage Test — Existing Duct System Pae 1 of 2 Site Address: Enforcement Agency: Permit Number: 54733 System2 Inverness Way La Quinta CA 92253 La Quinta, City of 12-1426 Enter the Duct System Name or Identification/Tag: Enter the Duct System Location or Area Served: Home 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 existingparts 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. ❑� Option 1. Measured leakagelessthan 15% of Fan Airflow. �+� y ❑Option til' !W aid _ �l, IA rfor a 91 ❑ Option 3. R'educe'dleak ge by 0% or nr d� aa� r lta - ❑ Option N Fix apll acces ble le ks usi snmia est -and ERS -rater rr ust-, rtk Note: (Opt'on 1 Jusst�ttempt'd before.0 'lizing Option 4)-",\ ) Determine no nal Fan Air B"A using ane o the following thrd�e calculaton methods. El Cooling system method: Sizeof condEn<s r in Tons 3-5 400 -, T 0 Flv1 ❑ Heating system method: 21.7 FIeating Ou..tput _Cap'aitFy k$tuh .,"CFM ❑ Measured system airflow using RA3.3 airflow tlst CF 1V procedures: Option 1 used then: Allowed leakage = Fan Airflow 1400 x 0.15 = 210 CFM 1 Actual leakage= 92 CFM Pass if Actual leakage is less than Allowed leakage El Pass [IFail Option 2 used then: Allowed leakage = Fan Airflow X0.10= CFM 2 Actual leakage to outside = CFM Pass if Actual leakage to outside is less than Allowed leakage ❑ Pass ❑ Fail Option 3 used then: Initial leakage prior to start of work= CFM Final leakage after sealing all accessible leaks using smoke test = CFM 3 Initial leakage - Final leakage = Leakage reduction CFM (Leakage reduction / Initial leakage ) x 100% = % Reduction Pass if % Reduction > 60% ❑Pass ❑Fail Option 4 used then: 4 All accessible leaks repaired using smoke test. HERS rater must verify (No sampling). Pass if all accessible leaks have been sealed using Smoke Test ❑Pass []Fail Registration Number: 313-A0014222A-M2114233A-0000 2008 Residential Compliance Forms Registration Date/Time: 01/30/2013 11:14:20 HERS Provider: CBPCA August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS Duct Leakage Test — Existing Duct System (Page 2 of 2) Site Address: Enforcement Agency: Permit Number: 54733 System2 Inverness Way La Quinta CA 92253 La Quinta, City of 12-1426 0 Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off during duct leakage testing. CFI OA ducts that utilize controlled motorized dampers, that open only when OA ventilation is required to meet ASHRAE Standard 62.2, and close when OA ventilation is not required, may be configured to the closed position during duct leakage testing. 0 All duct le New ductAnstallations cakt un�Ur D Mastic and draw bands` m�us�t ill e used .nn com inaffon wi th c1ofHlbac�,,ek d7ugb'be ad� duct connections. DECLARATION -STATEMENT • I certify under penalty of perjury, under th laws of the State of-califomia Ili o ibn • I am eligible under Division 3 o [lie BuRtiess and Etofessions Code to c re6n§ibili .j representative of the person responsible for consruction (responsible person). • I certify that the installed features, materials, components, or, manufactured devices identifi conforms to all applicable codes and regulations, and the ins allation is consistent with the enforcement agency. e — applies to )ed above. n esive duct tape to seal leaks at all new >rm is true and correct. or anlauthorized this certifi�,caate (thetinstallation) ind,spedificationsapproved by the • I understand that a HERS rater will check the installation to verify compliance, and that that if such checking identifies defects, 1 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 -I R) form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF -1 R 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. 1 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) Venvest Ballard/One Hour Air Responsible Person's Name: Responsible Person's Signature: Ruth Debrick Ruth Debrick CSLB License: Date Signed: Position With Company (Title): 878533 11/30/2013 Is this installation monitored by a Third Party Quality Control Name of TPQCP (if applicable): Program (TPQCP)? ❑Yes ONo Registration Number: 313-A0014222A-M2114233A-0000 Registration Date/Time: 01/30/2013 11:14:20 HERS Provider: CBPCA 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure Pae 1 of 5 Site Address: Enforcement Agency: Permit Number: 54733 Systeml Inverness Way La Quinta CA 92253 La Quinta, City of 12-1426 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 requiredfor 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 forms) 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 Goodman System Location or Area Served ®Yes Home ThAener is factory installed, or field' st 47dac��rding tmanufact�lrer's sci ff ctatio; or is in tailed by tliodCSpeciii afions awed by the Executive 6 []Yes 1 D s ONo 5/16_ inch (8-mm)access hole upstream of evaporative coil in the return plenum and The sensor wire is terminated with a standard mi0plug su`itbl for connection to a ifr%rna a t e e -a 'r%WV. 2 ❑Yes ` —N - - l c m acce le downstrea of evaporative coiI rl the supply plenum ONo / 5 and a r ct' o Yes to 1 ant is atpass. The sensor measures the saturation temperature of the coil within 1.3 degrees F ,t_Enter Pass -or Fail ✓ ❑ Pass ✓ ❑ Fail V \/ STMS - Sensor on the Eyaaorator Coil System Nam or IdentificationlT ig Goodman 3 ®Yes ONo ThAener is factory installed, or field' st 47dac��rding tmanufact�lrer's sci ff ctatio; or is in tailed by tliodCSpeciii afions awed by the Executive 6 []Yes ❑No -Oirector. --- The sensor wire is terminated with a standard mi0plug su`itbl for connection to a 4 ❑Yes ONo digital thermomefe'rrT he sensor mini plug is accessible-to=the nstall ng technician and 7 OYes ONo the HERS rater without changing the airflow through the condenser coil 5 Oyes DNo 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 ✓ pl N/A ✓ ❑ Pass ✓ 0 Fail STMS - Sensor on the Condenser Coil System Name or Identification/Tag Goodman 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 OYes ONo 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 ❑IYes ONo The 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 applicable. Otherwise enter Pass or Fail ✓ p N/A ✓ ❑ Pass ✓ ❑ Fail Registration Number: 313-A0014220A•M2514231A-0000 2008 Residential Compliance Forms RegistrationDate/Time: 01/30/201311:04:20 HERSProvider: CBPCA August 2009 INSTALLATION CERTIFICATECF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5) Site Address: Enforcement Agency: Permit Number: 54733 Systeml Inverness Way La Quinta CA 92253 La Quinta, City of 12-1426 Standard Charge Measurement Procedure (for use if outdoor air dry-bulb is above 55 °F) Procedures for determining Refrigerant Charge using the Standard Charge Measurement Procedure are available in Reference Residential Appendix RA3.2. As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional forms) for any additional systems in the dwelling as applicable. • The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure • The system must meet minimum airflow requirements as prerequisite for a valid refrigerant charge test. • If outdoor air dry-bulb is 55 °F or below, the installer must use the Alternate Charge Measurement Procedure. Space Conditionine Svstems System Name or Identification/Tag I Goodman I 1 .1 1 System Location or Area Served Home be re -calibrated monthly) Date of Thermocouple aldbr h 20 12/1 12 ..' Outdoor Unit Serial # 1206456963 Outdoor Unit Make Goodman Supply (evaporator leaving) air dry-bulb Outdoor Unit Model GSX130421 temperature (Tsu I , db) 50.00 Nominal Co f4i C a�'. Date of Veriftcattion� � +200 00 i 1?/5Lgn19 Return (evaporator entering) air dry-bulb of Di Date of Refirigeral�Ga Gal.ibation �.-, X2/,1/2012(must 5 be re -calibrated monthly) Date of Thermocouple aldbr h 20 12/1 12 ..' (rmust e-rje-calikated monthly) Measured Temnernhirac 101Pl 11 A System Name or Identification/Tag Goodman I. Supply (evaporator leaving) air dry-bulb 'L__ temperature (Tsu I , db) 50.00 Return (evaporator entering) air dry-bulb temperature (Tretum, db) 73.00 Return (evaporator entering) air wet -bulb temperature (Tretum, wb) 53.00 Evaporator saturation temperature (Teva orator, sat) 34.00 Condensor saturation temperature . (Tcondensor, sat) 79.00 Suction line temperature (Tsuction) 51.00 Liquid Line Temperature (Tliquid) 67.00 Condenser (entering) air dry-bulb temtemperature (Tcondenser, P ( condenser db) Registration Number: 313-AOOI 4220A -M2514231 A-0000 Registration Date/Time: 01/30/2013 11:04:20 HERS Provider: CBPCA 2008 Residential Compliance Forms August 2009 INSTALLATION CERTIFICATE I CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5) Site Address: I Enforcement Agency: Permit Number: 54733 System1 Inverness Way La Quinta CA 92253 La Quinta, City of 1-12-1426 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 Goodman Calculate: Actual Temperature Split = 23.00 Tretum, db - Tsupply, db Target Temperature Split from Table 22.00 RA3.2-3 using Tretum, wb and Tretum, db Calculate difference: Actual Temperature Split — Target Temperature Split = 1.00 Passes if difference is between -3 F and _ Pass ry�+�, +3°F or, up n 1? b jeI �' ii ! Vrrin U YI' -3°F and -1 n er Pa��'OFFaSI� �I Note: Tempe`atureAlit Method Calcu a et' s ligMA0 _ ne of the airflow measurem ent procedu e shecifi d.in Refeer nc�Ressidential ppe t� . 3. If actual cooling coil airflow is measured, the value must be equ I to or greater than the OWc-ulated M rri hinan lir flo Requirement in the table below. Calculated 'nimum rflo �Requirent 300 (CFA1) _ p�1r omintal Cooling Capacity (t/on� X'W fin/ton) System Name or Identification/T�g-__,,Goodman I Calculated Minimum Airflow El Requirement (CFM) Measured Airflow using RAU procedures (CFM) Passes if measured airflow is greater than or equal to the calculated minimum airflow requirement. Enter Pass or Fail. Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for fixed orifice metering device systems System Name or Identification/Tag Goodman Calculate: Actual Superheat = Tsuction — Teva orator sat Target Superheat from Table RA3.2-2 using Tretum, wb and Tcondenser, db Calculate difference: Actual Superheat — Target Superheat = System passes if difference is between -5°F and +5°F Enter Pass or Fail Registration Number.- 313-Ao01422OA-M2514231A-0000 2008 Residential Compliance Forms RegistrationDate/Time: 01/30/201311:04:20 HERSprovider: CBPCA August 2009 INSTALLATION CERTIFICATE I CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5) Site Address: Enforcement Agency: Permit Number: 54733 System1 Inverness Way La Quinta CA 92253 La Quinta, City of 12-1426 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 Goodman Calculate: Actual Subcooling = i. I It bF Tcondenser, sat — Tli uid 12.00 V i n i,a n e Target Subcooling specified by 10.00 •' �,� manufacturer 611 _ 5 - _ Calculate difference: 2.00 Actual Subcooling —Target Subcooling= System passes if difference is between Pass -3°F and +3°F Enter Pass or Fail Pass �► Metering Device Calculations for Refrigerant Charge Verification. This procedure is required to be used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/TagGoodman - i. I It bF Calculate::Meju it In U I If V i n i,a n e Tsuction — Teva orator sat 01p, AAL •' �,� _ Enter allowable superheat range rom1 611 _ 5 - _ manufacturer's spetcl icatlons'(o use rang between 4°F and 25°F if manufacturer's specification is nokavailable)� System passes actual supeeaj is witln the allowable superheaLr-ange Pass �► Enter Pas or Fail Registration Nwnber: 313-AO014220A-M2514231A-0000 2008 Residential Compliance Forms RegistrationDate/Time: 01/30/201311:04:20 HERSProvider: CBPCA August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5 Site Address: Enforcement Agency: Permit Number: 54733 Systeml Inverness Way La Quinta CA 92253 La Quinta, City of 12-1426 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 Goodman System meets all refrigerant charge and Pass airflow requirements. Enter Pass or Fail aflyo n C a 1,ding, relirformance ontimactofrs- Association s. .ti. DECLARATION.STATEMENT • 1 certify under penalty of perjuryunder tl e.la s of the State of California ,f1't? Ifo yion�pi via /on thiNorm is true and correct. • 1 am eligible under Division 3 o the Bulluess and rofessiolsCode to asst 1e `p nl;iEili, for Conshuc,tion, or an authorized representative of the person responsible for cons ruction (responslfil • 1 certify that the installed features, materials, compo Bents, or manufactured devices identifiedin this cee to (th tinstallation) conforms to all applicable codes and regulations, and'the-installation is consistent with the plans`and pecifications 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. 1 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 -I R) form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF -IR 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 I, 2010, for all low-rise residential buildings. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) Venvest Ballard/One Hour Air Responsible Person's Name: Responsible Person's Signature: Ruth Debrick Ruth Debrick CSLB License: Date Signed: Position With Company (Title): 878533 11/30/2013 owner Is this installation monitored by a Third Party Quality Control Name of TPQCP (if applicable): Program (TPQCP)? []Yes [Z]No Registration Nwnber: 313-AO01 4220A -M2514231 A-0000 2008 Residential Compliance Forms RegistrationDate/Time: 01/30/201311:04:20 HERSProvider: CBPCA August 2009 INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 5) Site Address: Enforcement Agency: Permit Number: 54733 System2 Inverness Way La Quinta CA 92253 La Quinta, City of 12-1426 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 forms) 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 Amana Amana System Nameoorr Identificatiouff to System Location or Area Served Home 6 ❑Yes ❑No 1 s ❑No 5/16 inch (8 mm) access hole upstream of evaporative coil in the return plenum and ❑No si'fication !or is installe thodsfspecificions approved by the Executive `Director. I :Jab.%jdjajqj1�i4 2t *qe nen 2 OYes' `W ®Yes - c m acce' h le downstrea of evapocative„coil" n the supply plenum '. digital thermometer. The sensor mini plug is accessible to the installing technician and The sensor wire is terminated with a standard mini pug suitabl for connection to a 4 a d a ,t� ct'. Yes to 1 ant is a,pas nter Pass or- Fail ✓ ❑ Pass ✓ ❑Fail V STMS - Sensor on the Evaaorator Coil STMS - Sensor on the Condenser Coil System Name or Identification/Tag Amana System Nameoorr Identificatiouff to Amana 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 ThelenAr is factory 01statfed, orfief,' sit lie ,Goading to manufacturer's 3 Dyes ❑No si'fication !or is installe thodsfspecificions approved by the Executive `Director. The sensor wire is terminated with a standard mini plug suitable for connection to a - ®Yes E]No digital thermometer. The sensor mini plug is accessible to the installing technician and The sensor wire is terminated with a standard mini pug suitabl for connection to a 4 ❑Yes ❑No digital thermorfei`ery'The sensor mini plug is accessibte,o°the nstalhng technician and ❑IYes ❑No The sensor measures the saturation temperature of the coil within 1.3 degrees F the HERS rater without changing the airflow through the condenser coil 5 ❑Yes ❑No 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 ✓ ❑I N/A ✓ ❑Pass ✓ El Fail STMS - Sensor on the Condenser Coil System Name or Identification/Tag Amana 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 E]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 ❑IYes ❑No The 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 applicable. Otherwise enter Pass or Fail ✓ p N/A ✓ El Pass ✓ E) Fail Registration Number: 313-AOO 1422 2A-M2514234A-0000 2008 Residential Compliance Forms Registration Date/Time: 01/30/2013 11:16:53 HERS Provider: CBPCA August 2009 INSTALLATION CERTIFICATE , I CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5) Site Address: Enforcement Agency: Permit Number: 54733 System2 Inverness Way La Quinta CA 92253 La Quinta, City of 12-1426 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. Saace Conditionine Svstems System Name or Identification/Tag I Amana System Location or Area Served Home Outdoor Unit Serial # 1204706986 Outdoor Unit Make Goodman Outdoor Unit Model GSX130421 Nominal Co 'Mitt C a -t B i &4000a00 t UE11"Mman-al rot NO' ew- 11or I - Date of Verific_tion i _12/5420.12 _ ,, _ rb of mvntk Date of Refr�igerant�Gauge Galibation.2/,1/2012 Amana (must be re -calibrated monthly) Date of Thermocouple Calliibra 12/1 2012 Supply (evaporator leaving) air dry-bulb (mustbg,_re-calli rated monthly) Measured Temneratures (OF) System Name or Identification/T'ag Amana Supply (evaporator leaving) air dry-bulb t temperature (Tsu I , db) 50.00 Return (evaporator entering) air dry-bulb temperature (Treturn, db) 73.00 Return (evaporator entering) air wet -bulb temperature (Tretum, wb) 53.00 Evaporator saturation temperature (Teva orator, sat) 32.00 Condensor saturation temperature (Teondenson sat) 87.00 Suction line temperature (Tsuction) 42.00 Liquid Line Temperature (Tliquid) 76.00 Condenser (entering) air dry-bulb temtemperature (Tcondenser, P ( condenser db) Registration Number: 313-AOO I 4222A-M2514234A-0000 Registration Date/Time: 01/30/2013 11:16:53 HERS Provider: CBPCA 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: 54733 System2 Inverness Way La Quinta CA 92253 La Quinta, City of 7 12-1426 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 Amana Calculate: Actual Temperature Split = 23.00 Tretum, db - Tsupply, db Target Temperature Split from Table 22.00 RA3.2-3 using Tretum, wb and Tretum, db Calculate difference: Actual Temperature Split — Target Temperature Split = 1.00 Passes if difference is between -37 and Pasts; +3°F or, up�F' e �1asa ulIidli p �'il �� r +GB -3°F and -I _ erl Note: Temperature Split McAd Calcu a i '•t � t' e s • '' A ling , l . r I- _nce one of the airflow meas urem ent procedure SpecifiLd-in Raferenc�R. ential App 3. /factual cooling coil airflow is ba,culated measured, the value must be equal to or greater th�n the .... iifoi in the table below. Calculated Minimum A nal .Requirement flo�.v�Requirme nt (CFM) = Nr om Cooling Cad patty (tong X`w 300 fin/ton) System Name or Identification/TL—JN.,,`---,eAmana Calculated Minimum Airflow Requirement (CFM) Measured Airflow using RA3.3 procedures (CFM) Passes if measured airflow is greater than or equal to the calculated minimum airflow requirement. Enter Pass or Fail Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used for fixed orifice metering device systems System Name or Identification/Tag Amana Calculate: Actual Superheat = Tsuction - Teva orator sat Target Superheat from Table RA3.2-2 using Tretum, wb and Tcondenser, db Calculate difference: Actual Superheat - Target Superheat = System passes if difference is between -5°F and +5°F Enter Pass or Fail Registration Number: 313-A0014222A-M2514234A-0000 2008 Residential Compliance Forms RegistrationDate/Time: 01/30/201311:16:53 HERS Provider- CBPCA August 2009 INSTALLATION CERTIFICATE , v • 0 CF-6R-MECH-25-HERS Refri erant Charge Verification - Standard Measurement Procedure (Page 4 of 5) Site Address: Enforcement Agency: Permit Number: 54733 System2 Inverness Way La Quinta CA 92253 La Quinta, City of 12-1426 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 Amana Calculate: Actual Subcooling = Tcondmser, sat - Tlicluid 11.00 o n cS Target Subcooling specified by 10.00 -. ",• manufacturer 00 - 1 4.9 ~11 0 - - - - Calculate difference: 1.00 Actual Subcooling - Tar et Subcooling = System passes if difference is between Pass -3°F and +3°F Enter Pass or Fail Pass Metering Device Calculations for Refrigerant Charge Verification. This procedure is required to be used for Registration thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems. System Name or Identification/Tag Amana Calculate: C42t,aI , Id, 0 o n cS - -- - Tsuction — Teva orator satto— w -. ",• 'e Enter allowatb`le superheat rangzfrom 00 - 1 4.9 ~11 0 - - - - manufacturer's specificattons`(oruse rang - between 4°F and 25°F if manufa-turer's specification is 11ohavaila6le —11 System passes •iif actulksuperhdal is within the allowable superheatzange ( Pass Enter Pa s or Fail- ai Registration Number: 313-AO014222A-M2514234A-0000 2008 Residential Compliance Forms RegistrationDate/Time: 01/30/201311:16:53 HERSProvider: CBPCA August 2009 INSTALLATION CERTIFICATE 4 2 1 , CF-6R-MECH-25-HERS Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5 Site Address: Enforcement Agency: Permit Number: 54733 System2 Inverness Way La Quinta CA 92253 La Quinta, City of 12-1426 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 Amana System meets all refrigerant charge and Pass airflow requirements. Enter Pass or Fail Performance California uilding r --- +'` i DEC LARATIONyS_ A� TEMENT • I certify under penalty of perjury under n,,Ia of the State of California th' fo ionrpr V' bd on t�form is true and correct. • I am eligible under Division 3 o the Bu 1 ess and Erofessio s Code to acme;f"r Sp�{5I 11 Ii f r co�tion, or an authorized 1 onsib. representative of the person responsib a for cons ruction (responsible person). — • I certify that the installed features, materials, components, or manufactured devices identifie oT this c�c�ate (th yinstallation) conforms to all applicable codes and regulations, and the irr, allation is consistent with the plans,andspeclficahans-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 -I R) form approved by the enforcement agency that identifies the specific requirements for the installation. 1 certify that the requirements detailed on the CFA R 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) Venvest Ballard/One Hour Air Responsible Person's Name: Responsible Person's Signature: Ruth Debrick Ruth Debrick CSLB License: Date Signed: Position With Company (Title): 878533 1/30/2013 owner Is this installation monitored by a Third Party Quality Control Name of TPQCP (if applicable): Program (TPQCP)? ❑Yes ❑� No Registration Number: 313-AO014222A-M2514234A-0000 2008 Residential Compliance Forms RegistrationDate/Time: 01/30/201311:16:53 HERSProvider: CBPCA August 2009