13-0066 (MECH),.: .
P.O. BOX 1504 VOICE (760) 717-7012
78-495 CALLE TAMPICO 4Y�N_ 1 FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 1/22/13
Application Number: 13-00000066 Owner:
Property Address: —56384 PEBBLE BEACH WELLS ROCKFORD
APN: 775-131-083- - - 56384 PEBBLE BEAC
Application description: MECHANICAL LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 11000
Contractor:
Applicant: Architect or Engineer: AIR EXPERTS AIR CONDITIONG-HTG
PO BOX 94 A
ILA LA QUINTA, CA 92247
(760)777-1724
Lic. No.: 725283 JA_N Old
-------------------—-------------------'----------------------------------- —,----�IFY ---- ----
LICENS RACTOR'S DECLARATION
I hereby affirm under penalty of perjury that m livens under provisions of Chapter 9 (commencing with
Section 00) of,Division 3 of the Busin79 and P ssionals Code, and my License is in full force and effect.
License lass: /20 License No.: 725283
Date: (� Contractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500):
1 _ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,.
and who does the work himself or herself through his or her own employees, provided that the
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
one year of completion, the owner -builder will have the burden of proving that he or she did not build or
improve for the purpose of sale.).
(_ 1 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_) I am exempt under Sec. , B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name: _
Lender's Address:
LQPERMIT
WORKER'S COMP RATION
I hereby affirm under penalty •of perjury one of the following declarations:
I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
Code, for the performance of the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier NORGUARD INS Policy Number PAWC334856
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 eco subject to the workers' compensation laws of California,
and agree that, if I should ecome lett to the the
compensation provisions of Section
3 00 of the Labor Code I sh rthwith comply with those provisions.
Date: -) Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 1$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 160 days will subject
permit to cancellation.
I certify that I have read this application and state that th ova i rmation is correct. 1 agree to comply with all
city and c my or nances and state laws relating to building struction, and hereby authorize representatives
of this co ty to ter upon the above-mentioned prop(ert r inspection purposes.
Date: ` 2 �" gnature (Applicant or Agent): .I
Application Number . . . . . 13-00000066
Permit . . . MECHANICAL
Additional desc .
Permit Fee 66.00 Plan Check Fee
16.50
Issue Date Valuation . . . .
0
Expiration Date 7/21/13
Qty Unit Charge Per
Extension
BASE FEE
15.00
2.00 9.0000 EA MECH FURNACE <=100K
18.00
2.00 16.5000 EA MECH B/C >3-15HP/>100K-500KBTU
33.00
---------------------------------------------------------
Special Notes and Comments
-----------
REPLACE (2) PACKAGE A/C HEATING UNITS 13
SEER (1) 3 TON AND (5) TON PER 2010
CODES.
--=-------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
Due
--------- ---------- ---------- ----------
Permit Fee Total 66.00 .00 .00
66.00
Plan Check Total 16.50 .00 .00
16.50
Other Fee Total 1.00 .00 .00
1.00
Grand Total 83.50 .00 .00
83.50
LQPERMIT
Bio. #
C' O/f, � QiJ1n , r y {'.'.
La
LQ
Btdkgpg 8t Safety Division
P.O. Box 1504,'78-49S Cane Tampko
U-Quinta, CA 92255 - (760) 777-7012
Building Permit APPlication'and Tracking Sheet
Perinit #
Address _
'ZaProjecr
Owner's Name:. p
A P. Number.
Address: 3�
Legal Description:
City, ST, Zip: L.,4 Q u .x!774 S-3
Contractor. /Q �XP�
Telephone:
Address: �Zj /-xX� S
•
Project Description:
/^ /� �n"w p —7
City, ST, Tap: UA t S�l.t w' l CA 7 zz q /�i4
C� . Z
Telephone: "7(eo 7Z° 1
qcimtyl,
L — A/
State Lia # :
Arch.,'Eng, Designer;
Address:
City, ST. Zip:
Telephone:
State I to #•
Name of Contact
Construction Type:. Occupancy:
Project We (circle one): New Add'n Alter Repair Demo
Sq. Sq. Ft.:
# Stories:
# unit$:
Telephone # of Contact Petsan:
Estimated Value of Project Q o
APPLICANT:
DO NOT WRITE BELOW THIS UNE
f+
Submittal
Rcq'd
1_ -Reed
TRACMG
PERMIT FEES
Piga Seb
Plan Cheep submitted
Item Amoaat
Strucufal Cafes.
Reviewed, ready for corrections
Plan Check Det.
Truss Calot,
Called Contact Person
Plan Check Balance.
'title 74 Caka,
Plans picked up
Construction '
Flood plain plea
Plan resubmitted ,
Mechakilcal
Grading plea
Z`! Review, ready for correctiousrrssue
Fdeotrieal
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
SM,L
ILO.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''' Review; ready for eorrectionsrmuc
Developer Impact Fee
Planning Approval
Called Contact Perron
A.I.P.P.
Pub. Wlw- Appr '
Dau of permit Issue
Stbool Fen
Total Permit Feu
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-IR-ALT-HVAC
Climate Zones 10 - 1S
Site Address:
Enforcement Agency:
Date:
Permit #:
56384 Pebble Beach ( system 2) La Quinta, CA 92253
City of La Quinta
]an 21, 2013
Duct insulation
Conditioned Floor
Equipment Typel
List Minimum Efficiency2
requirement
Area
Thermostat
.H Package Unit
JgFurnace
(3 Indoor Coil
❑ AFUE
® SEER 13.0
❑ COP
® HSPF 7.7
13 R 6 (CZ 10-13)
[3 R 8 (CZ 14-15)
Served system
2000 Sf
® Setback
If not already present, must be
.[3 Condensing Unit
[3EER
[3 Resistance
installed)
❑ Other
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF-IR-ALT-HVAC for each system.
2. Minimum Equipment Efficiencies: 13 SEER, 78% AFUE, 7.7HSPF for typical residential systems.
HERS VERIFICATION SUMMARY Listed below are FOUR HVAC alteration Options. The installer decides what work is being done
and picks one of the appropriate Options. Each Option lists the HERS measures that must be conducted. A copy of the forms shall
be left on site for final inspection and a copy given to the homeowner. At final, the inspector verifies that the work listed on this
form was in fact the work completed by the installer. The inspector also verifies that each appropriate CF-6R and registered CF-411
forms (no hand filled CF-4Rs allowed) are filled out and signed.Beginning October 1, 2010, a registered copy of the CF-111
and CF-6R shall also be on site for final inspection.
® 1. HVAC Changeout
Required Forms: -
. All HVAC Equipment
CF-611 forms: MECH-04, MECH-2I-HERS and (fff split systems) MEGH 25_W ERS
replaced
CF-4R forms: MECH-21 ,R,, (feF split systems)MEGH -L
. Condenser Coil and /or
. Indoor Coil and /or
CF-611 forms: MECH-04, MECH-2I-HERS @Rd (:'B- split systems) MEGH 25-14=oI;
. Furnace
CF-411 forms: MECH-21 ,Ra i(„- split systems) MEGH
For Packaged Units: Duct leakage < 15 percent
Exempted from duct leakage testing if:
❑ 1. Duct 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 Mini-SplitSystem),(Also Exempt from RefrigeraheCharge)
❑ 2. New HVAC System
Required Forms: t I} v
. Cut in for Changeout with.
new ducts: all new
( -
ducting and all new
-r ij
CF-H=256R forms: MECH-04, MECH-20-HERS, and'(for split systems) MECH-22=HERS, and
MEC=HERS _ `�;- -
ti
CF, R forms: MECH-20, and (for split systems) MECH-22, and MEt- 25 j
-
equipment)__,�,.of j
y,'
For Split Systems: Duct leakage < 6 percent; RC, CCA >_ 350 CFM/ton; FWD, TMAH, STMS, and either HSPP or PSPP.
For Packaged Units: Duct leakage < 6 percent _
❑ 3. New Ducts with/or without
Required Forms:
Replacement
. Includes replacing or installing all new
f ,
ducting and/or outdoor condensing unit
CF-611 forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS
and/or indoor coil and/or furnace. No or some
CF-411 forms: MECH-20 and (for split systems) MECH-25
equipment changed.
For Split Systems: Duct leakage < 6 percent; RC, CCA >_ 300 CFM/ton, TMAH
For Packaged Units: Duct leakage < 6 percent
❑ 4. New Ducting over 40 feet
Required Forms:
. Includes adding or replacing more than 40
CF-611 forms: MECH-04, MECH-2I-HERS
linear feet of duct in unconditioned space.
CF-4R forms: MECH-21
For split system or packaged units: Duct leakage < 15 percent
❑ EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos.
Contractor (Documentation Author's /Responsible Designer's Declaration Statement)
. I certify that this Certificate of Compliance documentation is accurate and complete.
. I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of
Compliance.
. I certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the
requirements of Title 24, Parts 1 and 6 of the California Code of Regulations.
. The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance
forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with the permit application.
Name: Paul Van Vlymen Signature: Paul Van Vlymen
Company: AIR EXPERTS AIR CONDITIONING-HEATING Date: ]an 21, 2013
Address: PO BOX 94 License: 725283
City/State/Zip: LA QUINTA / CA / 92247-0094 Phone: (760) 777-1724
Reg: 213-A0004103A-000000000-0000 Registration Date/Time: 2013/01/21 15:46:17 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms July 2010
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF-IR-ALT-HVAC
Climate Zones 10 - 15
Site Address:
Enforcement Agency:
Date:
Permit #:
56384 Pebble Beach ( system 1 ) La Quinta, CA 92253
City of La Quinta
Jan 21, 2013
Duct insulation
Conditioned Floor
Equipment Type1
List Minimum Efficiency2
requirement
Area
Thermostat
® Package Unit
p Furnace
p Indoor Coil
i] AFUE
® SEER 13.0
p COP
® HSPF 7.7
17 R 6 (CZ 10-13)
Served by system
® Setback
If not already present, must be
p Condensing Unit
p EER
Q Resistance
13 R 8 (CZ 14-15)
1200 sf
installed)
p Other
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF-IR-ALT-HVAC for each system.
2. Minimum Equipment Efficiencies: 13 SEER, 78% AFUE, 7.7HSPF for typical residential systems.
HERS VERIFICATION SUMMARY Listed below are FOUR HVAC alteration Options. The installer decides what work is being done
and picks one of the appropriate Options. Each Option lists the HERS measures that must be conducted. A copy of the forms shall
be left on site for final inspection and a copy given to the homeowner. At final, the inspector verifies that the work listed on this
form was in fact the work completed by the installer. The inspector also verifies that each appropriate CF-611 and registered CF-411
forms (no hand filled CF-4Rs allowed) are filled out and signed.Beginning October 1, 2010, a registered copy of the CF-111
and CF-611 shall also be on site for final inspection. _
® 1. HVAC Changeout
Required Forms:
• All HVAC Equipment
CF-611 forms: MECH-04, MECH-2I-HERS a^a (far split ,...,.t,.ms) M=.-1.25 HERS
replaced
CF-411 forms: MECH-21 and (fn- split systems) 04EG14 2
• Condenser Coil and /or
• Indoor Coil and /or
CF-6R forms: MECH-04, MECH-2I-HERS _Rd (f^F Split 25 14ERS
• Furnace
+ CF-4R forms: MECH-21 -� (fSF splitsystems) M=GH-2&
POF Split SyStSMSE Duet leakage -Q 19 peFeeRti RG, GGA 15 990 Gr-04�t8R (MiRimum AiF WSW RequiremeRt), 4:04A4
For Packaged Units: Dud leakage < 15 percent
Exempted from dud leakage testing if:
❑ 1. Dud system was documented to have been previously sealed and confirmed through HERS verification, or
❑ 2. Dud systems with less than 40 linear feet in unconditioned space, or
p 3. Existing dud systems are constructed, insulated or sealed with asbestos
❑ 4. Thesystem,will not be Ducted (ie.,Ductless,Mini-SplitSystem)'(AlsoIExerript from Refrigerant' Charge)
❑ 2. New HVAC System
Required Forms:
. Cut in for Changeout with
new ducts: all new
(
- k - r _ ,.
CF 6R forms: MECH-04, MECH-20=HERS, and (for split systems) MECH-22and r
dudirig and all new
y
MEC5=HERS =
CF-4R form� s: MECH-20, and (for split systems) MECH=22, and MECH-25j r
equipment
For Split Systems: Duct leakage < 6 percent; RC, CCA >_ 350 CFM/ton,.FWD, TMAH, STMS, and either HSPP or PSPP.
For Packaged Units: Duct leakage < 6 percent
O 3. New Ducts with/or without
Required Forms:
Replacement
. Includes replacing or installing all new
ducting and/or outdoor condensing unit
CF-6R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS
and/or indoor coil and/or furnace. No or some
CF-4R forms: MECH-20 and (for split systems) MECH-25
equipment changed.
For Split Systems: Duct leakage < 6 percent; RC, CCA >_ 300 CFM/ton, TMAH
For Packaged Units: Duct leakage < 6 percent
4. New Ducting over 40 feet
Required Forms: t
• Includes adding or replacing more than 40
CF-611 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 Title 24, Parts 1 and 6 of the California Code of Regulations.
• The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance
forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with the permit application.
Name: Paul Van Vlymen Signature: Paul Van Vlymen
Company: AIR EXPERTS AIR CONDITIONING-HEATING Date: Jan 21, 2013
Address: PO BOX 94 License: 725283
City/State/Zip: LA QUINTA / CA / 92247-0094 Phone: (760) 777-1724
Reg: 213-A0004102A-000000000-0000 Registration Date/Time: 2013/01/21 15:42:51 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms July 2010
y
INSTALLATION CERTIFICATE CF-6111-MECH-0
Space Conditioning Systems, Ducts and Fans (Page 1 of 2)
Site Address:
56384 Pebble Beach(,system'1'),,La Quinta CA 92253
Enforcement Agency:
Permit Number:
—
(System 1) — - 1
City of La Quinta
13-66
Space Conditioning Systems
Heating Equipment
Equip
Type
(package-
heat pump)
•
CEC Certified Mfr. Name
and Model Number
ARI
Reference
Number2
# of
Identical
Systems
Efficiency
(AFUE,
etc.)1, 3
(>=CF -1R
value)4
Duct
Location
(attic,
crawl-
space,
etc.)
Duct
R -value
Heating
Load
(kBtu/hr)
Heating
Capacity
(kBtu/hr)
Package
Furnace
MAYTAG
PPG2GFX36K100XA
4402360
1
80 AFUE
Attic
R-4.2
80
100 kBtu
F f
C', - r
cooing cquipmenr +
Equip
Type
(package
heat
pump)
Y
CEC Certified Mfr. Name
and Model Number
ARI
Reference
Number2
# of
Identical
Systems
Efficiency
(SEER
and EER)
1, 3
(>=CF -SR
value)4
Dud
Location
-(attic,
crawl-
space,
etc.)
Dud
R -value
Cooling
Load
(kBtu/hr)
Cooling
Capacity
(kBtu/hr)
Package
A/C
' �, MAYTAG
PPG2GFX36K100XA , ,
�+"�.r
4402360
r -`'
1
15 -SEER -%i
12 EER
��.+•
Attic
}
R 4
36
3 Tons
F f
C', - r
A. 1f Y1U1C« 1b new cu115uucLivrn, see roornoces Lo aranaaras tame 151-C ana iaoie 151-L ror auct cening alternative
compliance.
2. ARI Reference Number can be found by entering the equipment model number at
http://www. addirectory. org/ari/ac. php#
3. Listed efficiency on this page must be greater than or equal ( ? ) to the value shown on the CF -1R form. ,
4. When CF -IR is reference it is also applicable to the CF -1R, CF -IR -AA or CF -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).
® §150U)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.
Reg: 213-A0004102A-M0400001A-0000 Registration Date/Time: 2013/01/23 16:22:45 - HERS'Provider:,Ca10ERTS, Inc.
2008 Residential Compliance Forms August 2009
i
INSTALLATION CERTIFICATE CF-611-MECH-0
Space Conditioning Systems, Ducts and Fans (Page 2 of 2)
Site Address:
56384 Pebble Beach ( system 1 ), La Quinta CA 92253
Enforcement Agency:
Permit Number:
(System 1)
City of La Quinta
13-66
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.
❑ 2D. Joints and seams of duct systems and their components shall not be sealed with cloth back
rubber adhesive duct tapes unless such tape is used in combination with mastic and draw bands.
❑ 7. Exhaust fan systems have back draft or automatic dampers.
❑ 8. Gravity ventilating systems serving conditioned space have either automatic or readily accessible,
manually operated dampers.
❑ Protection of Insulation. Insulation shall be protected from damage, including that due to sunlight,
moisture, equipment maintenance, and wind. Cellular foam insulation shall be protected as above or
painted with a coating that is water retardant and provides shielding from solar radiation that can cause
degradation of the material. r
❑ 10. Flexible ducts cannot have p.�o`rous,inne.r cores.
/
DECLARATION STATEMENT
. I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct.
. I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized
representative of the person responsible for construction (responsible person).
. I certify that the installed features, materials, components, or manufactured devices identified on this certificate (the installation)
conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the.
enforcement agency.
. I reviewed a copy of the Certificate of Compliance (CF -111) form approved by the enforcement agency that identifies the specific
requirements for the installation. I certify that the requirements detailed on the CF -1R that apply to the installation have been met.
. I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the
building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I
understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder
provides to the building owner at occupancy.
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
Air Experts Air Conditioning
Responsible Person's Name:
Responsible Person's Signature:
Paul Van Vlymen
Paul Van Vlymen
CSLB License:
725283
Date Signed:
1/22/2013
Position With Company (Title):
Reg: 213-A0004102A-M0400001A-0000 Registration Date/Time: 2013/01_/23 16:22:45 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms August 2009
INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS
Dud Leakage Test — Existing Duct System (Page 1 of 2)
Site Address:
56384 Pebble Beach ( system 1 ), La Quinta CA 92253
Enforcement Agency:
Permit Number:
(System 1)
City of La Quinta
13-66
Enter the Duct System Name or Identification/Tag: System 1
Enter the Duct System Location or Area Served: BEDROOMS
Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the
1welling.
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
rhe 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 Leakaqe Diaqnostic Test - existino duct system
Select one compliance method from the following four choices.
® 1. Measured leakage less than 15% of fan Flow
0 2. Measured leakage to outside less than 10% of Fan Flow
0 3. Reduce leakage by 60% and conduct smoke and fix all leaks
0 4. Fix all accessible leaks using smoke and HERS rater verify
Note: (One of Options 1, 2 or 3 must be attempted, before utilizing Option4.)_
Determine nominal Fan Flow using one of the following three calculation methods./fir ,► ar,
✓
0 Cooling system method: Size of condenser in Tons 13 x 400 = ! 1200 CFM
✓ 0 Heating system 21.7 x Output Capacity
method: in Thousands of Btu/hr = _ CFM
✓
❑Measured system airflow using.RA3.3 airflow test procedures: CFM
Option 1 used then:
. 1- -
1
Allowed leakage = Fan Airflow 1200 x 0.15 = 180 CFM
Actual Leakage= 141 CFM
Pass if Actual Leakage is less than Allowed leakage
M Pass r3 Fail
Option 2 used then:
2
Allowed leakage = Fan Airflow _ x 0.10 = _ CFM
Actual Leakage to outside = CFM
Pass if Actual leakage to outside is less than Allowed leakage
Pass 0 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 repaired using smoke
Pass a Fail
Reg: 213-A0004102A-M2100001A-0000 Registration Date/Time: 2013/01/23 16:23:36 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS
Duct Leakage Test - Existing Duct System (Page 2 of 2)
Site Address:
56384 Pebble Beach ( system 1 ), La Quinta CA 92253.
Enforcement Agency:
Permit Number:
(System 1)
City of La Quinta
13-66
4
® Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off
during duct leakage testing. CFI OA ducts that utilize controlled motorized dampers, that open only when OA•
ventilation is required to meet ASHRAE Standard 62.2, and close when OA ventilation is not required, may
be configured to the closed position during duct leakage testing.
® All supplyand return register1b00ts4pust belsealed to the drywall if,smoke test is utilized for compliance
- applies�torduct leakage compliance option 3 (leakage reduction. by 60%) and option 41(fix all'accessible
leaks) described above..`.�"
%ra,n7n641u!J1ize r - w Y
® New ductLiin�st�ajlllations, building cavities asiplenums)or platform returnps in lieu of ducJtys... x1 4
-.% `-,....X'f •Y. W W.w''b`- i(A�kiKr
® Mastic and draw bands must be' used in combination with cloth backed rubber adhesive duct -tape to seal
leaks at all new duct connections
DECLARATION STATEMENT
. I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct.
• I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized
representative of the person responsible for construction (responsible person).
• I certify that the installed features, materials, components, or manufactured devices identified on this certificate (the installation)
conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the
enforcement agency.
• I understand that a HERS rater will check the installation to verify compliance, and that that if such checking identifies defects, I am -
required to take corrective action at my expense. I understand that Energy Commission and HERS provider representatives will also '
perform quality assurance checking of installations, including those approved as part of a sample group but not checked by a HERS
rater, and if those installations fail to meet the requirements of such quality assurance checking, the required corrective action and
additional checking/testing of other installations in that HERS sample group will be performed at my expense. '
• I reviewed a copy of the Certificate of Compliance (CF -SR) form approved by the enforcement agency that identifies the specific
requirements for the installation. I certify that the requirements detailed on the CF -111 that apply to the installation have been met.
• I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the
building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I -
understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder
provides to the building owner at occupancy. I will ensure that all Installation Certificates will come from a HERS provider data
reaistry for multiDle orientation alternatives. and heainninn nrtnhar 1 _ gni n fnr All in„„-rica rac„lantiai ho du.fi.,ne
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
Air Experts Air Conditioning
Responsible Person's Name:
Responsible Person's Signature:
Paul Van Vlymen
Paul Van Vlymen 1.
CSLB License:
725283
Date Signed:
1/22/2013
Position With Company (Title):
Is this installation monitored by a Third Party Quality
Name of TPQCP (if applicable):
Control Program (TPQCP)? ❑ Yes ❑ No
Reg: 213-A0004102A-M2100001A-0000, Registration Date/Time: 2013/01/23 16:23:36 HERS Provider: Ca10ERTS; Inc.
2008 Residential Compliance Forms March 2010.
i
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-21
Duct Leakage Test — Existing Duct System (Page 1 of 2)
Site Address:
56384 Pebble Beach ( system 1 ), La Quinta CA 92253
Enforcement Agency:
Permit Number:
(System 1)
City of La Quinta
13-66
Enter the Duct System Name or Identification/Tag: System 1 of 2
Enter the Duct System Location or Area Served: Bedroom
Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the
dwelling.
This installation certificate is required for compliance for alterations and additions in existing dwellings to
space conditioning systems and duct systems.
Note: For existing dwellings, a completely new or replacement duct system can also include existing parts of
the original duct system (e.g., register boots, air handler, coil, plenums, etc.) if those parts are accessible
and they can be sealed. For a completely new or replacement duct system installed in an existing dwelling, -
use the Installation Certificate titled "Duct Leakage Test - Completely New or Replacement Duct System. "
Duct Leakage Diagnostic Test - existing duct system
Select one compliance method from the following four choices.
® 1. Measured leakage less than 15% of fan flow
0 2. Measured leakage to outside less than 10% of Fan Flow
0 3. Reduce leakage by 60% and conduct smoke and fix all leaks
0 4. Fix all accessible leaks using smoke and HERS rater verify
Note: (One of Options_i, 2, or 3 must be attempted.; before. utilizing Option 4.)_
Determine nominal Fan Flow using one of=the following three calculation methods.#-
✓ M Cooling system method: Size of condenser in Tons 13 x 400 =1 1200 CFM -
✓ 0 HeaSting system method: 21.7 z I Output Capalcity in Thous�a/nnds of,Btu/hr = _CFM
r}
ng M✓ 0 Measured system airflow using RA3.3 ain90tstProcedures: CF
Option 1 used then:
1
Allowed leakage = Fan Flow 1200 x 0.15 = 180 CFM
Actual Leakage = _ 141 CFM -
Pass if Leakage Actual is less than Allowed
IN
Pass E3 Fail
Option 2 used then:
2
Allowed leakage = Fan Flow _ x 0.10 = _ CFM
Actual Leakage to outside = _ CFM
Pass if Leakage Actual is less than Allowed
Pass 0 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%
a Pass a Fail
Option 4 used then:
4
All accessible leaks repaired using smoke test. HERS rater must verify (No sampling).
Pass if all accessible leaks have been repaired using smoke
p Pass El Fail
Reg: 213-A0004102A-M2100001A-M21A Registration Date/Time: 2013/01/23 17:18:02 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms March 2010
V_� . T
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-21
Duct Leakage Test - Existing Duct System (Page 2 of 2)
Site Address:
56384 Pebble Beach ( system 1 ), La Quinta CA 92253
Enforcement Agency:
Permit Number: '
(System 1)
City of La Quinta
13-66
® Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off
during duct leakage testing. CFI OA ducts that utilize controlled motorized dampers, that open only when OA
ventilation is required to meet ASHRAE Standard 62.2, and close when OA ventilation is not required, may,
be configured to the closed position during duct leakage testing.
® All supplyran' d re�ttuurn register b ots must be sealed�to�^th drywall ISI f,s oke ted s' t lize comp
— applies'to' duct leakage compliance option 3 (leakage reductip"n by 60%) and option 0(fix all accessible
leaks) described abo -
® New duct installations ,cannot utilize'.building cavities ashplenums or platform returns in lieu of ducts.
® Mastic and draw bands must be used in combination with cloth backed rubber adhesive duct tape to seal. .
leaks at all new duct connections.
DECLARATION STATEMENT
• I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct.
• I am the certified HERS rater who performed the verification services identified and reported on this certificate (responsible rater).
• The installed feature, material, component, or manufactured device requiring HERS verification that is identified on this certificate (the
installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified
on the Certificate(s) of Compliance (CF -1R) approved by the local enforcement agency. . • ,
. The information reported on applicable sections of the Installation Certificate(s) (CF -611), signed and submitted by the person(s)
responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -111) approved by the
enforcement agency.
Builder or Installer information as shown on the Installation Certificate (CF -6111)
Company y NamI e Installing Subcontractor or General Contractor or Builder/Owner)
Reg: 213-A0004102A-M2100001A-M21A Registration Date/Time: 2013/01/23 17:18:02 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms March 2010
AIR EXPERTS AIR CONDITIONING -HEATING
Responsible Person's Name:
CSLB License:
Paul Van Vlymen
1725283
HERS Provider Data Registry Information
Sample Group # (if applicable): 384251
® tested/verified dwelling :
❑ not-tested/verified dwelling in
la
HERS sample group
HERS Rater Information CalCERTS Certificate # CCI -1798724833
HERS Rater Company Name:
Air Solutions of the Desert
Responsible Rater's Name:
Responsible Rater's Signature:
Walter W Nellis
Walter W Nellie
Responsible Rater's Certification Number w/ this HERS Provider:
Date Signed: 1/23/2013
CC2004361
Reg: 213-A0004102A-M2100001A-M21A Registration Date/Time: 2013/01/23 17:18:02 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms March 2010
' J
Space Conditioning Systems, Ducts and Fans (Page 1 of 2)
r 1 -
Enforcement Agency:
Permit Number:
'1)
INSTALLATION CERTIFICATE CF-6111-MECH-0
Space Conditioning Systems, Ducts and Fans (Page 1 of 2)
Site Address: I
56384 Pebble Beach._( system•2-),-La Quinta CA 92253
Enforcement Agency:
Permit Number:
'1)
City of La Quinta
13-66
Space Conditioning Systems
Heating Equipment
Equip
Type
(package-
heat pump)
'
CEC Certified Mfr. Name
and Model Number
ARI
Reference
Number2
# of
Identical
Systems
-
Efficiency
(AFUE,
etc.)1, 3
(>=CF -SR
value)4
- Duct
Location
(attic,
crawl=
space,
etc.) .
Duct
R -value
Heating
Load
(kBtu/hr)
Heating
Capacity
(kBtu/hr)
Package
Fumace
MAYTAG
PPG2GFX60K120XA
4402380
1
-
80 AFUE
Attic
R-4.2
96
120 kBtu
N
,
a.00nna caummenc
Equip
Type
(package
heat
pump)
CEC Certified Mfr. Name
and Model Number
ARI
Reference
Number -2
# of
Identical
Systems
Efficiency
(SEER
and EER)
1,3
(>=CF -1R
value)4
Duct
Location
(attic, "
crawl-
space,
etc.)
Duct
R -value
Cooling
Load
(kBtu/hr)
Cooling
Capacity
(kBtu/hr)
Package
A/C
� VJMAYTAG
PPG2GFX60K120XA
- `�i
4402380/
- -�
1
15 SEER—
12 EER
Attu-
i R-4.2
j'
T60Y
5 Tons
N
,
— a LdJnSLIuL.LIVII, SCC ruuuwce5 Lu JLdnOdro5 (dole 1z)1 -b dna /aDle 1.51-L ror auct ceiling alternative
compliance.
2. ARI Reference Number can be found by entering the equipment model number at
http://www. aridirectory. orglarilac. php# - -
3. Listed efficiency on this page must be greater than or equal ( ? ) to the value shown on the CF -1R foam.
4. When CF -IR is reference it is also applicable to the CF -IR, CF -IR -AA or CF -IR -ALT
ALL BOXES MUST BE CHECKED TO BE A VALID FORM' -
10 §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).
® §150U)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.
• n • 1 i. ti
Reg: 213-A0004103A-M0400001A-0000 Registration Date/Time: 2013/01/23-16:28:01, HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms 1 August 2009
INSTALLATION CERTIFICATE CF-6111-MECH-0
Space Conditioning Systems, Ducts and Fans (Page 2 of 2)
Site Address:
Site
56384 Pebble Beach (system 2 ), La Quints CA 92253
Enforcement Agency:
Permit Number:
Paul Van Vlymen
City of La Quinta
13-66
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.
❑ 2D. Joints and seams of duct systems and their components shall not be sealed with cloth back
rubber adhesive duct tapes unless such tape is used in combination with mastic and draw bands.
❑ 7. Exhaust fan systems have back draft or automatic dampers.
❑ 8. Gravity ventilating systems serving conditioned space have either automatic or readily accessible,
manually operated dampers.
❑ Protection of Insulation. Insulation shall be protected from damage, including that due to sunlight,
moisture, equipment maintenance, and wind. Cellular foam insulation shall be protected as above or
painted with a coating that is water retardant and provides shielding from solar radiation that can cause
degradation of the material.
❑ 10. Flexible.,ducts cannot have porousTinner cores..,..?
ry�
DECLARATION STATEMENT
. I certify under penalty of perjury, under the laws of the State of Califomia, the information provided on this form is true and correct.
. I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized
representative of the person responsible for construction (responsible person).
. I certify that the installed features, materials, components, or manufactured devices identified on this certificate (the installation)
conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the
enforcement agency.
. I reviewed a copy of the Certificate of Compliance (CF -111) form approved by the enforcement agency that identifies the specific
requirements for the installation. I certify that the requirements detailed on the CF -111 that apply to the installation have been met.
. I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the
building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I
understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder
provides to the building owner at occupancy.
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
Air Experts Air Conditioning
Responsible Person's Name:
Responsible Person's Signature:
Paul Van Vlymen
Paul Van Vlymen
CSLB License:
725283
Date Signed:
1/22/2013
Position With Company (Title):
Reg: 213-A0004103A-M0400001A-0000 Registration Date/Time: 2013/01/23 16:28:01 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms August 2009
INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS
Duct Leakage Test — Existing Duct System (Page 1 of 2)
Site Address:
56384 Pebble Beach ( system 2 ), La Quinta CA 92253
Enforcement Agency:
Permit Number:
(systemt
City of La Quinta
13-66
Enter the Duct System Name or Identification/Tag: System 1
Enter the Duct System Location or Area Served: LIVING AREA
Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the
dwelling.
This installation certificate is required for compliance for alterations and additions in existing dwellings to
space conditioning systems and duct systems.
Note: For existing dwellings, a completely new or replacement duct system can also include existing parts of
the original duct system (e.g., register boots, air handler, coil, plenums, etc.) if those parts are accessible
and they can be sealed. For a completely new or replacement duct system installed in an existing dwelling,
use the Installation Certificate titled "Duct Leakage Test - Completely New or Replacement Duct System. "
Duct Leakage Diagnostic Test - existing duct system
Select one compliance method from the following four choices.
® 1. Measured leakage less than 15% of fan flow
❑ 2. Measured leakage to outside less than 10% of Fan Flow
❑ 3. Reduce leakage by 60% and conduct smoke and fix all leaks
❑ 4. Fix all accessible leaks using smoke and HERS rater verify
;
Note: (One of Options 1, 2 or 3 must be attempted,before-_utilizing , Option 4.)_
Determine, nominal Fan Flow using one of -the following three calculation methods.
✓ ® Cooling `system method: Size of condenser in Tons 15 x 400 = 2006 CFM
✓ ❑ Heating I
system method: 21.1 x� Output Capacity in Thousands of Btu/hr = _ CFM
-10 Measured system airflow using 'RA3.3 airflo tw est procedures CFM_
'�/ -
Option 1 used then:_
1
Allowed leakage = Fan Airflow2000 x 0.15 = 300 CFM '
Actual Leakage= 162 CFM
Pass if Actual Leakage is less than Allowed leakage
Pass Fail
Option 2 used then: ;
2
Allowed leakage = Fan Airflow _ x 0.10 = _ CFM
Actual Leakage to outside = CFM
Pass if Actual leakage to outside is less than Allowed leakage
0 Pass Fail .
Option 3 used then:
Initial leakage prior to start of work = _ CFM
Final leakage after sealing all accessible leaks using smoke test = _ CFM
3
Initial leakage _ - Final leakage _ = Leakage reduction CFM
((Leakage reduction _ / Initial leakage _) x 100% _ • o Reduction
` Pass if % Reduction >= 600/6
Pass Fail
Option 4 used then: I
4
All accessible leaks repaired using smoke test. HERS rater must verify (No Sampling).
Pass if all accessible leaks have been repaired using smoke
Pass Fail
i
Reg: 213-A0004103A-M2100001A-0000 Registration Date/Time:-2013/01/23 16:28:48 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS
Duct Leakage Test — Existing Duct System (Page 2 of 2)
Site Address:
56384 Pebble Beach ( system 2 ), La Quinta CA 92253
Enforcement Agency:
Permit Number:
t
City of La Quinta
13-66
® 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 dud leakage testing.
® All supply..and return register'boots-must beisealed to the drywall if,smoke testis utilized for compliance
— applies�to dud leakage compliance option 3 (leakage reduction,by 60%) and option 41(fix all'�accessible
leaks) described abov
® New dud installations cannot utilize building cavities as)plenums)or platform returns in lieu of ducts... +s�
® Mastic and draw bands must be used in combination with cloth backed rubber}adhesive duct`tape to seal
leaks at all new dud connections
DECLARATION STATEMENT
• I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct.
• I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized
representative of the person responsible for construction (responsible person).
• I certify that the installed features, materials, components, or manufactured devices identified on this certificate (the installation)
conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the
enforcement agency.
. I understand that a HERS rater will check the installation to verify compliance, and that that if such checking identifies defects, I am
required to take corrective action at my expense. I understand that Energy Commission and HERS provider representatives will also
perform quality assurance checking of installations, including those approved as part of a sample group but not checked by a HERS
rater, and if those installations fail to meet the requirements of such quality assurance checking, the required corrective action and
additional checking/testing of other installations in that HERS sample group will be performed at my expense.
. I reviewed a copy of the Certificate of Compliance (CF -1R) form approved by the enforcement agency that identifies the specific
requirements for the installation. I certify that the requirements detailed on the CF -1R that apply to the installation have been met.
• I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the
building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I
understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder
provides to the building owner at occupancy. I will ensure that all Installation Certificates will come from a HERS provider data
reaistry for multiole orientation alternatives. and heoinninn nrtnhpr 1 7m n fnr au i„w r—irlanri,f k.dl —
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
. L
Responsible Person's Name:
Responsible Person's Signature:
Paul Van Vlymen
t
® 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 dud leakage testing.
® All supply..and return register'boots-must beisealed to the drywall if,smoke testis utilized for compliance
— applies�to dud leakage compliance option 3 (leakage reduction,by 60%) and option 41(fix all'�accessible
leaks) described abov
® New dud installations cannot utilize building cavities as)plenums)or platform returns in lieu of ducts... +s�
® Mastic and draw bands must be used in combination with cloth backed rubber}adhesive duct`tape to seal
leaks at all new dud connections
DECLARATION STATEMENT
• I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct.
• I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized
representative of the person responsible for construction (responsible person).
• I certify that the installed features, materials, components, or manufactured devices identified on this certificate (the installation)
conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the
enforcement agency.
. I understand that a HERS rater will check the installation to verify compliance, and that that if such checking identifies defects, I am
required to take corrective action at my expense. I understand that Energy Commission and HERS provider representatives will also
perform quality assurance checking of installations, including those approved as part of a sample group but not checked by a HERS
rater, and if those installations fail to meet the requirements of such quality assurance checking, the required corrective action and
additional checking/testing of other installations in that HERS sample group will be performed at my expense.
. I reviewed a copy of the Certificate of Compliance (CF -1R) form approved by the enforcement agency that identifies the specific
requirements for the installation. I certify that the requirements detailed on the CF -1R that apply to the installation have been met.
• I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the
building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I
understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder
provides to the building owner at occupancy. I will ensure that all Installation Certificates will come from a HERS provider data
reaistry for multiole orientation alternatives. and heoinninn nrtnhpr 1 7m n fnr au i„w r—irlanri,f k.dl —
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
Air Experts Air Conditioning
Responsible Person's Name:
Responsible Person's Signature:
Paul Van Vlymen
Paul Van Vlymen
CSLB License:
725283
Date Signed:
1/22/2013
Position With Company (Title):
Is this installation monitored by a Third Party Quality
Name of TPQCP (if applicable):
Control Program (TPQCP)? ❑ Yes ❑ No
Reg: 213-A0004103A-M2100001A-0000 Registration Date/Time: 2013/01/23 16_:28:48 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
171
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-21
Dud Leakage Test — Existing Duct System (Page 1 of 2)
Site Address:
56384 Pebble Beach ( system 2 ), La Quinta CA 92253
Enforcement Agency:
Permit Number:
City of La Quinta
13-66
Enter the Duct System Name or Identification/Tag: System
Enter the Duct System Location or Area Served: Whole House
Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the
dwelling.
This installation certificate is required for compliance for alterations and additions in existing dwellings to
space conditioning systems and duct systems.
Note: For existing dwellings, a completely new or replacement duct system can also include existing parts of
the original duct system (e.g., register boots, air handler, coil, plenums, etc.) if those parts are accessible
and they can be sealed. For a completely new or replacement duct system installed in an existing dwelling,
use the Installation Certificate titled "Duct Leakage Test - Completely New or Replacement Duct System. "
Duct Leakage Diagnostic Test - existing duct system
Select one compliance method from the following four choices.
❑ 1. Measured leakage less than 15% of fan flow
❑ 2. Measured leakage to outside less than 10% of Fan Flow
❑ 3. Reduce leakage by 60% and conduct smoke and fix all leaks
.
❑ 4. Fix all accessible leaks using smoke and HERS rater verify
Note: (One of Optionsj, 2, or 3 must be attempted,before,utilizing Option,�4 )W
Determinepbrninal Fan Flow using one of -the following three calculation methods.,
✓ ❑ Cooling system method: Size of x
condenser in Tons i M
= .� CF -
,400
#
0
`
2117 x
Heating system _Output Capacity in et4od:Output Capacity in /h
yds of Btur = CFM_.•
• �r f P ��
✓ stt R
res-: �•J CFM, Measured Yi
,sym , ,;�
5!i `•�
Option 1 used then:
- -
1
Allowed leakage = Fan Flow _ x 0.15 = _ CFM
Actual Leakage `_ _ CFM
i Pass if Leakage Actual is less than Allowed
h Pass E3 Fail
Option 2 used then: i
2
Allowed leakage = Fan Flow r x 0.10 = —CFM
Actual Leakage to outside = CFM
_
Pass if Leakage Actual is less than Allowed
Pass Fail
Option 3 used then:
Initial leakage prior to start of work = _ CFM
Final leakage after sealing all accessible leaks using smoke test = _ CFM
3
Initial leakage _ - Final leakage _ = Leakage reduction CFM
((Leakage reduction _ / Initial leakage x 100% _ % Reduction
Pass if % Reduction >= 60%
Pass Fail
Option 4 used then:
4
All accessible leaks repaired using smoke test. HERS rater must verify (No sampling).
Pass if all accessible leaks have been repaired using smoke
p Pass a Fail
I
Reg: 213-A0004103A-M2100001A-M21A Registration Date/Time: 2013/01/23 17:18:02 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms March 2010 -
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-21
lk
•
Enforcement Agency:
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-21
Duct Leakage Test — Existing Duct System (Page 2 of 2)
Site Address:
56384 Pebble Beach ( system 2 ), La Quinta CA 92253
Enforcement Agency:
Permit Number:
(�)
City of La Quinta
13-66
O 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. ;
f R"r i4-
❑ All supply/and return register boots must be sealed to the drywall if, smoke test Is utilized forj, compliance .
— applies+to'duct leakage compliance option 3 (leakage reduction by 60%) and option 4%fix all'accessible
leaks) described abov,�e (` {
❑ New duct installations cannot utilize building cavities asf lenums}or latform return�s�in lieu of ducts a
O Mastic and draw bands must be used in combination with cloth backed rubber adhesive duct tape to seal
leaks at all new duct connections.
DECLARATION STATEMENT
• I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct.
• I am the certified HERS rater who performed the verification services identified and reported on this certificate (responsible rater), t ..
• The installed feature, material, component, or manufactured device requiring HERS verification that is identified on this certificate (the
installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified
on the Certificate(s) of Compliance (CF -1R) approved by the local enforcement agency.
. The information reported on applicable sections of the Installation Certificate(s) (CF -611), signed and submitted by the person(s)
responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -111) approved by the
enforcement aaencv.
Builder or Installer information as shown on the Installation Certificate (CF -6R)
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) ,
AIR EXPERTS AIR CONDITIONING -HEATING
Responsible Person's Name:
CSLB License:
Paul Van Vlymen
172S283
HERS Provider Data Registry Information
Sample Group # (if applicable): 384251
❑ tested/verified dwelling
FIRMnot-tested/verified dwelling in
ERS sample group
HERS Rater Information CaICERTS Certificate # CC1-1798724834
HERS Rater Company Name: ,
Air Solutions of the Desert +
Responsible Rater's Name:
Responsible Rater's Signature:
Walter W Nellis
Walter W Nellis
Responsible Rater's Certification Number w/ this HERS Provider:
Date Signed: 1/23/2013 ,
CC2004361
Reg: 213-A0004103A-M2100001A-M21A. Registration Date/Time: 2013/01/23 17:18:02 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forma March 2010