12-1438 (MECH)uitr
P.O. BOX 1504 VOICE (760) 777-7012
(;e000"Y� - 4 4,
78-495 CALLE TAMPICO FAX (760) 777-7011
LA Q.UINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 12/17/12
Application Number: '2=00001438- Owner:
Property Address: 55499"OAK- HHILL BRENDA FRANK
APN: 775-231-033- - - 55499 OAK HILL
Application description: MECHANICAL " LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 6332
Contractor: n �'
Applicant: - Architect or Engineer:GENERAL AIR` CONDITIO ING [nj
31170 RESERVE' DRI I
THOUSAND PALMS, 9
• � (760) 343-7488
z 1'� Lic. No.: 686310
CITY.01F LA QUIPlTA `
FIN,;NCFd2EPT-.
--=---------------------------------------------------------------------------------------------—
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION.
hereby.affirm under, penalty of perjury that I -am -licensed under provisions of Chapter 9 (commencing with. I hereby affirm under.penalty,of perjury�onebf the following`declarations:,..
Section 7000) of Division 3 of the Business and Professionals Code, andmy License is in full force and effect. _ I have and will'n?aintain a certificate of "consent to self -insure for workers' compensation, as.provided
License Class -C20 • _ `"_ 1 L License,No.: '686310' for by Section -3700 of the Labor Code, -for the�perfoimance of the work for which this permit is
.� issued.
ate Z n �ontractor:✓ 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
OWNER -BUILDER -DECLARATION insurance carrier and policy number are: -
Thereby affirm under penalty, of perjury that;l;am exempt from the Contractor's State License Law.for.the Carrier ZENITH SNS CO' Policy Number Z071741502
following reason (Sec. 7031.5, Business aril Professionscode: Any city or county that requires a permit to _ I *certify that; in.the performance of the work for which this'permif is issued, I shall:not employ any
ep
construct, alter, improve, demolish, or raii anystructure, prior torits issuance,=also requires the applicant for the person in any manner so as to becomeesubject to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I should become subject to the workers' compensation provisions of Section
License Law:(Chapter 9 -(commencing With Section 7000) of:Division 3 of the Business and Professions Code) or • 3700 of the Labor Code, I shall forthwith comply with thoke provisions. .
`that he or she is ezeropt therefrom and. the basis for the alleged. exemption. Anyviolation of Secti6n,7031:5 by '
any applicant fora permit subjects the applicant to a civil, penalty of;not more than five hundred dollars (5.500).: ate
:7 1Z— plicant:
(_ ) "1, -as. owner of.the property, or my employees with wages:as'their- ole compensation, will do the work; and • "
• the structure isnot intended or,offered for'sale iSec."7044 Business and Professions'Code: -The WARNING.: FAILURE TO'SECURE.WORKERS' COMPENSATION COVERAGE .IS;UNLAWFUL„AND-SHALL
Contractors' State License Law does not apply to an owner of property<who b6ilds,or improves thereon, SUBJECT AN EMPLOYER'.TO CRIMINAL PENALTIES AND CIVIL FINES.UP TO.ONE,FiUNDRED THOUSAND
and who does the work himself or Herself through his!9i her own employees, provided that the DOLLARS (s10Q000). IN ADDITION TO THE -COST -OF COMPENSATION; DAMAGES AS PROVIDED FOR IN
improvements are not -intended or offered for sale., if„however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE,'INTEREST, AND.ATTORNEY'S FEES.:”.
one year of completion;"the owner -builder will have the burden. of proving that he or she did.not build or
improve for,the purpose of sale;). • APPLICANT ACKNOWLEDGEMENT -
(_) 1, as owner of.tfie property, -am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to'the Director of, Building and Safety for a permit subject to the
7044,. Business and Professions Code The Contractors' State License Law does not applyto. an,owner of ; . conditions and. restrictions setforth-on this applicatwn ” '"" _ `4' `' `" "' ' ••
property who builds or improves thereon,. a, who contracts for the projects with a contractors) licensed 1.. Each person upon whose behalf this application is made, each personal whose request and for
pursuantto the Contractors'„State License Law.). - whose; benefit'work is performed under or pursuant to any permit issued as a result of this application,
(_) I am exempt under Sec. - , 8.&P.C. for this reason c. the owner, and the applicant; each agrees to, and shall defend, indemnify, and hold harmless the City
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 ISec. 3097; Civ. C.).
Lender's Name: �•
Lender's Address:
LQPERMIT
of La 06inta, 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”! 80 days will subject
permit to cancellation.
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'
of this county to enter upon the above-mentioned opert fction purposes.
Date: k11-7 ignature (Applicant or Agent): �h
' LQPERMIT
Application Number ... . . . 12-00001438
Permit . . . MECHANICAL
Additional desc .
Permit Fee . . . . 24.00 Plan Check Fee
6.00
Issue Date Valuation
0
Expiration Date 6/15/13
Qty Unit Charge Per
Extension
BASE FEE
-15.00
1.00 9.0000 EA MECH•FURNACE <=100K
9.00
Specai.Notes"and Comments
HVAC.CHANGE-OUT: REPLACE 80 K BTU
FURNACE ,& "COIL. 2010 CODES:
----------------- .-- ---- ---------------- ----------------
Other Fees BLDG.STDS ADMIN (SB14Z3)`
1 00.
Fee summary Charged. Paid Credited
.Due
Permit Fee Total 24.'00 .00 ..00
24:00•
Plan Check Total 6.QO" >00, 00'
6.00
Obkier "Fee Total 1. 00 . 06 .06.
1. 0'0
Grand Total 31.00 .00 .00.
31.00
' LQPERMIT
Bin .#
Permit #
l
Project Address:'°fir
Ci�j! OF Qi11I7a
Building 8t Safety Division
PO. Box 1504,:76-495�Calle Tamplco
la.Qirinta, CA 92233 ;(760) 777=7012
Bwifding ;Permit Application and�TracSFeet
! 4 R q OC k 11 Owner's Name:. 3r�r�a R
A. P. Number .
y
Addressc y 1
554q�i^ V0. rt�i 1�
Description:
ContractorGepex-c,_N
Zp"r'Legal
" q ZZ53Cty,Z; .
Address: 3N�1Q`C�l�'
�'.V.�e.
1?ro�ectDescnption:�"Ok- 1��V
City, ST, Zip --W
0.lrYm.S ., 9Zz7b
�rce Col
Telephone: %&18
p 60 - 313- y 8Sy
�,
HIM
State Lic. #:, 31'0
City Lrc fit
. .
Arch., Migr., Designer. '
Address:
City., ST, Zip:
Telephone:Construction
State Lic. #::
Y
"
Type: Occupancy:
Project type.(circte one): Now Add'n .. Alter Repair Demo
Name of Contact Person:
'1151 ' . L
Sq Ft.:
#Stones
# Unita:
Telephone # of Contact Person:,"'
Esturiated'Value of Project , (o .3 3 Z . OO
:AP PLICANT:.DONOT 'WRITE`BELOW THIS',UNE;
fl
Submittal
Req'd
1I1ec'd
TRACICIPIC
PERMIT FEES
Plan Sets
Plan Check submitted ,
Item Amount
Structural Cafes.
Reviewed, ready'[or correctionsPlan'Chcch
Deposit. .
Truss Calcs.,Called
Contaet Person!Pian
Check Balance_
Title 24 Cates.
Plate pidred up:.
Cbnstrucden
Flood plain plan
Pians resubmitted...
Mechanical "
Grading plan
Z'` Revievi, ready for correctionsfissue
Electrical
Subcontaetor List
Called Contact Person
Plumbing
Grant Deed
Piansspicked up
H.O.A. Approval.
Plans resabinitted
Grading
IN HOUSE:-
Review, ready (or correctlonsrissge
Developer Impact Fee
Punning Approval
Called Contact Person
A.LP:P.
Pub. Wks. Apps"
Date of permit issue
School Fees
z
F1
Total Permit Fees
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVACAIterations CF -IR -ALT -HVAC
Climate Zones 10 to 15
Site Address:
Enforces ntAge my:
Date:
Permit #:
55499 OAK HILL
LA QUINTA I3&S
12/17/2012
Conditioned Floor
Equipment Type'
List Minimum Efficieney2Duct
insulation requirement
Area
Thermostat
❑ Packaged Unit
® Furnace
o
® AFUE 80%
E3 COP-
Over 40 ft of ducts added or
10 Setback
® Indoor Coil
❑SEER
❑ HSPF
replaced in unconditioned space
Served by system
(7f not already
❑ Condensing Unit
❑ EER
❑ Resistance
❑ R 6 (CZ 10-13)
❑ R 8 (CZ 14-15)
2100 sf
present, mnst be
installeio
❑ Other
1. Equipment Type: Choose the equipment being installed,• if more than one system, use another CF -1R ALT-HVACfor each system.
2. Minimum Equipment Efficiencies: 13 SEER, 78.9 AFUE, 7.7HSPFfor typical residential systems.
HERS VERIFICATION SUMMARY Listed below are four HVAC alteration Options. The installer decides what work is being done and
picks one of the appropriate Options. Each Option lists the HERS measures that must be conducted A copy of the forms shall be left on site for final
inspection and a copy given to the homeowner. At final, the inspector verifies that the work listed on this form was in fact the work completed by the
installer. The inspector also verifies that each appropriate CF -6R and registered CF -4R forms (no hand filled CF-4Rs allowed) are filled out and
signed. Beginning October 1, 2010 a registered copy of the CF -1R and CF -6R shall also be on site for final inspection.
®1. HVAC Chau eout
Required Forms:
CF -6R forms: MECH-04„MECH-21-HERS and (for split systems) MECH-25-HERS
• All HVAC Equipment replaced
CF -4R forms: MECH-21. and for split stems MF -CH -25
• Condenser Coil and/or
CF -6R forms: MECH-2I-HERS and (for split systems) MECH-25-HERS
• Indoor Coil and/or
CF -4R forms: MECH-21 and.(for split systems) MECH-25
• Purace
For Split Systems: Duct leakage < 15 percent; RC, CCA > 300 CFM/ton(Minimum Air Flow Requirement), TMAH
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. Existine duct systems are constru . cted, insulated or sealed with asbestos
0 2. New HVAC System
Required Forms:
• Cut in or Changeout with new .
CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS
ducts: (all new ducting and all
CF4R.forms: MECH-20, and (for split systems) MECH-22, and MECH-25
new equipment)
For Split Systems: Duct leakage <6 percent; RC, CCA> 350 CFM/ton, FWD, TMAH, STMS,`and either HSPP or PSPP.
For Packaged Units: Duct leakage < 6 percent
0 3. New Ducts with Replacement
R uired Forms:
• Includes replacing or installing all new ducting
CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-25-HERS
and/or outdoor condensing unit and/or indoor
CF4R forms: MECH-20 and (for split systems) MECH-25
coil and/or furnace. Not all equipment changed
For Split Systems: Duct leakage < 6 percent, RC, CCA > 300 CFM/ton, TMAH
For Packaged Units: Duct leakage < 6 percent
❑ 4. New Ducting over 40 feet
Required Forms:
• Includes adding or replacing more than 40
CF -6R forms: MECH-04, MECH-2I-HERS CF4R forms: MECH-21
linear feet of duct in unconditioned space.
For split system or packaged units: Duct leakage < 15 percent
❑ EXCEPTION: Existin 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.
• 1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of CorWhance.
• 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 fonts, worksheets,
calculationsplans and specificad2ns submitted to the enforcement agency for approval with thepermitapplication.
Name: STEVE SCHNIERER Signature:
Company: GENERAL AIR CONDITIONING & HEATING
Date: 12/17/2012
Address: 31170 RESERVE DRIVE
License: 686310
City/State/Zip: THOUSAND PALMS, CA 92276
Phone: 760-343-7488
2008 Residential Compliance Forms July 2010
CERTIFICATE, OF FIELD VERIFICATION & DIAGNOSTIC TESTING ' CF-4R-MECH-21
Duct Leakage Test - Existing Duct System' z (Page .i of 2)
Site Addressd. Enforcement Agency:Permit Number:
m
55499 OAK HILL, La Quinta CA 92253 (Systei) :City of La Quinta 12-1438
Enter the Duct System Name or Identification/Tag: S'y'stem 1 .
Enter the Duct System Location or Area Served: Whole House
Note: Submit one Installation Certificate for each. duct system that must demonstrate compliance in the
dwelling.
This installation certificate is required for compliance for alterations and additions in existing dwellings to
space conditioning systems and duct systems.
Note: For existing dwellings, a completely new or replacement duct system can also include existing parts of
the original duct system (e.g., register boots, air handler, coil, plenums, etc.) if those parts are accessible
and they can be sealed. For a completely new or replacement duct system installed in an existing dwelling,
use the Installation Certificate titled "Duct Leakage Test - Completely New or Replacement Duct System.'
Duct Leakage Diagnostic Test - existing duct system
Select one compliance method from the following four choices.
❑ 1. Measured leakage less than -15% of fan flow
❑ 2. Measured leakage to outside less than 10% of Fan Flow
❑ 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.
✓ ❑ Cool,ngrsystem method: Size ofV,condenser in Tons P x 406 _ CFM,1��
✓ ❑Heating. system method 21 7Ax Output Capacdy ,n�T.Housands of Btu/hr = CFM e°
✓❑ Measured system airflow us1ng;RA3 3 airflow test procedures: CFMx-.
Optwn:l,used thenw� € ry
1
Allowed leakage = Fan Flow x 0.15,=_CFM
Actual Leakage = _ CFM
Pass if Leakage Actual is less than Allowed
Pass 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
El
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 1 x 100% _.au Reduction
Pass- if % Reduction >= 60%
Pass 0 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 0 Fail
Reg: 212-A0072306A-M2100001A-M21A Registration Date/Time: 2013/01/02 21:24:38 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
U�:.
CERTIFICATE OF FIELD VERIFICATION 8c',D,IAGNOSTIC TESTING' . CF-4R-MECH-21
Duct Leakage Test;=_Existing Duct System. (Page,2 of 2)
Site Address: Enforcement Agency: Permit.Number:
55499 OAK HILL, La Quinta CA 9.2253 (System 1) City of La Quinta 12-1438
❑ Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off
during duct leakage testing. CFI OA ductv'that utilize controlled motorized dampers, that open only when OA
ventilation is required to meet ASHRAE Standard 62.2, and close when OA ventilation is not required, may
be configured to the closed position during duct leakage testing.
❑All supply and return register boots must behsealedytoFthedrywalL if smoke test -is utilized fo,ctcompliance
- applies toyduct leakage compliance option 3 (leakage -reduction by:60%) and option 4 (fx all accessible
'eileaks) described above. ;, ;•
F..
❑ New duct installations _canh6t utilize; building cavities aS plen`tims or platform r-.eturns in lieu,of.ducts..:
� ,+
❑Mastic and :draw bandsmust be usedxin combination.with.cloth backed rubber adhesive,:ducttape 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 -6R)
Company Name: (Installing Subcontractor or General Contractor'or Builder/Owner)
HARRISON ENTERPRISES INC
Responsible Person's Name:
CSLB Lice_ nse:
Danielle Garcia
1686310.
HERS Provider Data Registry Information
Sample Group # (if applicable): 377738tested/verified
❑ dwelling '10'•not-tested/verified
dwelling in
a HERS sample group
HERS Rater Information CalCERTS Certificate # CC1-17987.18323
HERS Rater Company Name:
Stratz Permit Service
Responsible Rater's Name:
Responsible Rater's Signature:
Garrett Williams
Garrett Williams
Responsible Rater's Certification Number w/ this HERS Provider:
Date Signed: 12/19/2012
CC2006208
Reg: 212-A0072306A-M2100001A-M21A Registration Date/Time: 2013/01/02 21:24:38 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING SCF-41k-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 5)
Site Address: Enforcement Agency: ,Permit Number:
55499 OAK HILL, La Quinta CA 92253 City of La Quinta 12-1438
Note: If installation of a Charge Indicator Display (CID) is utilized as an alternative to refrigerant charge verification for
compliance, a MECH-24 Certificate (instead of this MECH-25 Certificate) should be used to demonstrate compliance with
the refrigerant charge verification requirement. TMAH and STMS are not required for compliance, when a CID is utilized
for compliance.
As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional form(s) for
any additional systems in the dwelling as applicable.
Temperature Measurement Access Holes (TMAH) and Saturation Temperature Measurement
Sensors (STMS)
Procedures for installing TMAH are specified in Reference Residential Appendix RA3.2. If refrigerant charge verification is
required for compliance, TMAH are also required for compliance. STMS are only required for completely new or
replacement space -conditioning systems that utilize prescriptive compliance method.
TMAH - Access Holes in Supply and Return Plenums of Air Handler
System Name or Identification/Tag
System i.,..T
System Location or Area Served
Whole House
1
❑ Yes
❑ No
5/16 inch (8 mm) access hole upstream of evaporative coil in the return plenum and
labeled according to Figure in Section RA3.2.2.2.2.
2
❑ Yes
❑ No
5/16 inch (8 mm) access hole downstream of evaporative coil in the supply plenum
and labeled according to Figure in Section RA3.2.2.2.2.
Yes to 1 and 2 is a pass.
Enter Pass or Faill ✓ ❑ Pass ✓ ❑ Fail
STMS - Sensor,on,.the Evaporator Coil
System Name"or Identification/Tag
The sensor is factory installed, or field installed according to manufacturer's
The sensor is factory,mstalled, or field instam
lled according to anufacturer's
3
❑Yes
❑'No �S
specifications, or is,installed by methods/specification'sapproved'byrthe Executive
/ isDirector.
n.
k `ITKe-'lse'�nsor
wire is terminated with" standard mini plug suitable for connection;to a'
4
p=Yes
_ `. ❑ No
digital,thermometer"Tha sensor. rriini.plug:is„accessible to thesinstai.llm;g technician '
and the HERS rater without changing the airflow through the condenser coil
and th'e"HERSrater without changing the airflow through the condenser coil
5
❑ Yes
❑ No
When attached to a digital thermometer, the sensor provides an indication of the
saturation temperature of the coil.
saturation temperature of the coil.
Yes to 3, 4, and 5 is a pass. Enter N/A if STMS are not
✓ [I N/A
✓ ❑Pass
./ ❑Fail
applicable. Otherwise enter Pass or Fail
STMS - Sensor on the Condenser Coil
System Name or Identification/Tag I System 1
The sensor is factory installed, or field installed according to manufacturer's
6
❑ Yes
❑ No
specifications, or is installed by inethods/specifications approved by the Executive
Director.
The sensor wire is terminated with a standard mini plug suitable for connection to a
7
❑ Yes
❑ No
digital thermometer. The sensor mini plug.is accessible to the installing technician
and the HERS rater without changing the airflow through the condenser coil
8
❑ Yes
❑ No
When attached to a digital thermometer, the sensor provides an indication of the
saturation temperature of the coil.
Yes to 6, 7, and 8 is a pass. Enter N/A if STMS are not✓
® N/A
✓ ❑ Pass
V ❑ Fail
applicable. Otherwise enter Pass or Fail
Reg: 212-A0072306A-M2500001A-M25A Registration Date/Time: 2013/01/02 21:26:54 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
V f
CERTIFICATE OF FIELD VERIFICATION &-DIAGNOSTIC TESTING CF-411-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5)
Site Address: Enforcement Agency: Permit Number:
55499 OAK HILL, La Quinta CA 92253 City of La Quinta 12-1438
Standard Charge Measurement Procedure (for use if outdoor air dry-bulb is above 55°F)
Procedures for determining Refrigerant Charge using the Standard Charge Measurement Procedure are available in Reference Residential
Appendix RA3.2. As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional form(s) for
any additional systems in the dwelling as applicable.
• The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure.
• The system must meet minimum airflow requirements as prerequisite for a valid refrigerant charge test.
• If outdoor air dry-bulb is 55*F or below, the installer must use the Alternate Charge Measurement Procedure.
Space Conditionina Svstems
System Name or Identification/Tag
System 1
(must be re -calibrated monthly)
s;
Date of TheFmocouple!Calibration
System Location or Area Served
Whole House
Outdoor Unit Serial #
Outdoor Unit Make
Outdoor Unit Model
Nominal Cooling Capacity Btu/hr
Date of Verification
a uarn VI v.aMIIW LM LIMILI U911c"aS
Date of Refrigerant Gauge Calibration
;System 1
(must be re -calibrated monthly)
s;
Date of TheFmocouple!Calibration
(must be re calibrated monthly)
.•�co�u�cu:",�cn�yc�aau�Cs l' rl ��;,.; ..::,.. c�:.,,.. __
System Name or Identification/Tag
;System 1
Supply eve"oratorleavin
PP Y ( P 9)"air dry=bulb
temperature (Tsupply, db)
Return (evaporator entering) air -dry-bulb
temperature (Treturn, db)
Return (evaporator entering) air wet -bulb
temperature (Treturn, wb)
Evaporator saturation temperature
(Tevaporator,sat)
Condensor saturation temperature
(Tcondensor, sat)
Suction line temperature (Tsuction)
Liquid Line Temperature (Tliquid)
Condenser (entering) air dry-bulb
temperature (Tcondenser, db)
Reg: 212-A0072306A-M2500001A-M25A Registration Date/Time: 2013/01/02 21:26:54 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
INSTALLATION CERTIFICATE CF-4R-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5)
Site Address: Enforcement Agen77 Permit Number:
55499 OAK HILL, La Quinta CA 92253 City of La Quinta 12-1438
Minimum Airflow Requirement
Temperature Split Method Calculations for determining Minimum Airflow Requirement for Refrigerant Charge
Verification. The temperature split method is specified in Reference Residential Appendix RA3.2.
System Name or Identification/Tag
Calculate: Actual Temperature Split = Treturn, db
Tsupply,db
Target Temperature Split from Table RA3.2-3 using
Treturn, wb and Treturn, db
Calculate difference: Actual Temperature Split -
Target Temperature Split =
Passes if difference is between -4°F and +4°F or,
upon remeasurement, if between -4°F and -100°F
Enter Pass or Fail.
Note: Temperature Split Method Calculation is not necessary if actual Cooling Coil Airflow is verified using one of the
airflow measurement procedures specified in Reference Residential Appendix RA3.3. If actual cooling coil airflow is
measured, the value must be equal to or greater than the Calculated Minimum Airflow Requirement in the table below.
Calculated Minimum Airflow Requirement (CFM) = Nominal Cooling Capacity (ton) X 300 (cfm/ton)
System Name or Identification/Tag,.;wt-
Calculated Minimum Airflow:Requirement (CFM)
Measured;Airflow using RA13 procedures CFM)
Passes if measured airflow is greatertharror equal
to the calculated minimum airflow requirement.
Enter Pass or Fail
Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used
for fixed orifice metering device systems
System Name or Identification/Tag
Calculate: Actual Superheat =
Tsuction - Tevaporator, sat
Target Superheat from Table RA3.2-2 using
Treturn, wb and Tcondenser, db
Calculate difference:
Actual Superheat - Target Superheat =
System passes if difference is between -6°F and
+6°F
Enter Pass or Fail
Reg: 212-A0072306A-M2500001A-M25A Registration Date/Time: 2013/01/02 21:26:54 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
INSTALLATION CERTIFICATE CF-41R-MECH-2!
Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5]
Site Address: Enforcement Agency: Permit Number:
55499 OAK HILL, La Quinta CA 92253 City. of La Quinta 12=1438
Subcooling Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used
for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems.
System Name or Identification/Tag
Calculate: Actual Subcooling =
Tcondenser, sat - Tliquid
Target Subcooling specified by manufacturer
Calculate difference:
Actual Subcooling - Target Subcooling =
System passes if difference is between
-4°F and +4°F
Enter Pass or Fail
Metering Device Calculations for Refrigerant Charge. Verification. This procedure is required to be used for
thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems.
System Name or Identification/Tag
Calculate: Actual Superheat =
Tsuction - Tevaporator, sat
Enter allowable superheat range from
manufacturer's specifications (or use range
between 3°F and 26°F if manufacturer's
specification is not available)
System passes if actual superheat is withinthe
allowable superheat range
Enter Passor Fai
y >
Reg: 212-A0072306A-M2500001A-M25A Registration Date/Time: 2013/01/02 21:26:54 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
INSTALLATION CERTIFICATE,.. s..' CF-4R-MECH-25
Refrigerant Charge Verification,.- Standard. Mea'surement,'Peocedu:re (Page 5 of S)
Site Address: Enforcem'ent'Agency: -Permit Number:
55499 OAK HILL, La Quinta CA 92253 .City of La. Quinta . 12-1438
Standard Charge'Measurement Summary:
System shall pass both refrigerant charge criteria, metering device criteria (if applicable), and minimum cooling coil
airflow criteria based on measurements taken concurrently during system operation. If corrective actions were taken, all
applicable verification criteria must be re -measured and/or recalculated.
System Name or Identification/Tag
System 1
1686310
HERS Provider Data Reg istry,Inforniation
Sample Group # (if applicable): 377738
System meets all refrigerant charge and airflow
® not-tested/verified dwelling in
a HERS sample group
requirements.
P`vi r
Stratz Permit Service
Responsible Rater's Name:
Responsible, Rater's Signature:
Enter Pass or Fail
Garrett Williams,
Responsible Rater's Certification Number w/ this HERS Provider:
UP
CC2006208
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 HER S: verification that is identified on this certificate (the
installation) complies with the applicable requirements in Reference Residential'Appendices RA2 and RA3 and the requirements specified
on the Certificate(s) of Compliance (CF-111)•approved by the local- enforcement ;agency.
. The information reported on applicable sections of the Installation Certificate* (s)'(CF-6 R), signed and submitted by the person(s)
responsible forthe 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=(;R)
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
HARRISON ENTERPRISES INC
Responsible Person's Name:
CSLB License:
Danielle Garcia
1686310
HERS Provider Data Reg istry,Inforniation
Sample Group # (if applicable): 377738
❑ tested/verified dwelling
® not-tested/verified dwelling in
a HERS sample group
HERS Rater Information CaICERTS'Certificate # CC1-1798718323
P`vi r
Stratz Permit Service
Responsible Rater's Name:
Responsible, Rater's Signature:
Garrett Williams
Garrett Williams,
Responsible Rater's Certification Number w/ this HERS Provider:
UP
CC2006208
{
3
•
k
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 HER S: verification that is identified on this certificate (the
installation) complies with the applicable requirements in Reference Residential'Appendices RA2 and RA3 and the requirements specified
on the Certificate(s) of Compliance (CF-111)•approved by the local- enforcement ;agency.
. The information reported on applicable sections of the Installation Certificate* (s)'(CF-6 R), signed and submitted by the person(s)
responsible forthe 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=(;R)
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
HARRISON ENTERPRISES INC
Responsible Person's Name:
CSLB License:
Danielle Garcia
1686310
HERS Provider Data Reg istry,Inforniation
Sample Group # (if applicable): 377738
❑ tested/verified dwelling
® not-tested/verified dwelling in
a HERS sample group
HERS Rater Information CaICERTS'Certificate # CC1-1798718323
HERS Rater Company Name: '
Stratz Permit Service
Responsible Rater's Name:
Responsible, Rater's Signature:
Garrett Williams
Garrett Williams,
Responsible Rater's Certification Number w/ this HERS Provider:
Date Signed: '12/19./2012
CC2006208
Reg: 212-A0072306A-M2500001A-M25A Registration Date/Time: 2013/01/02 21:26:54 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010