MECH (12-0094)54120 Avenida Madero
12-0094
- iz
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 12=0000009
Property Address:
54.120 AVENIDA MADERO
APN:
774 -193 -025 -
Application description:
MECHANICAL
Property Zoning:
COVE RESIDENTIAL
Application valuation:
500
Tit v440"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
BUTLER FAMILY TRUST
54120 AVENIDA MADERO
LA QUINTA, CA 92253
Contractor:
Applicant: Architect or Engineer: ALL ABOUT AIR
PO BOX 5936
LA QUINTA, CA 92248 O
(760) 578-7913
PIA
Lic. No.: 874583
------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury t am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Bus( s and Professio s Code, and my License is in full force and effect.
License CI ss: C20 icense No.: 874563
ate: Z ) ntractar:_
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 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and .00
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.).
(_ 1 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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/02/12
Lm U
MAY 021011 L
3F
----------------- - -- - -
-
-----aisc ,-L- .--- _y ---
WORKER'S COMPENS I RC ARATI'ON
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 XEMPT Policy Number EXEMPT
PLI certify that, in the performance of the work for which this permit is issued, I shall not employ any
person in any manners s t become subje o the workers' compensation laws of California,
and agree that, if I sh Id come subject t th workers' compensation provisions of Section
3700 of the L or C •de shall forthwi r om y with those provisions.
ate: n/ 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-) have read this application and state that the Iorr
informati is rrt`ot. I agree to comply with all
city and ounty ordinances a state laws relating to builstruc ' , and reby authorize representatives
oft ' c nt to enter u the above-mentioned prop spe onurpos s.
ate: Signature (Applicant or Agent):
- - G
Application Number . . . . . 12-00000094
Permit . .
. MECHANICAL
Additional desc .
.
Permit Fee
24.00
Plan Check Fee
6.00
Issue Date . . .
.
Valuation . . .
. 0
Expiration Date
10/29/12
Qty Unit Charge Per
Extension
BASE
FEE
15.00.
1.00 9.0000
EA MECH
APPL REP/ALT/ADD
9.00
----------------------------------------------------------------------------
Special Notes and
Comments
REPLACE EVAPORATOR
COIL UNDER WARRANATY
(4 TON UNIT). 2010
CODES.
----------------------------------------------------------------------------
Other Fees . . .
. . . . . . BLDG STDS ADMIN (SB1473)
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
LQPERMIT
0
Simplified Prescriptive Certificate of Compliance: 2005 Residential HVACAlterations . CF -IR -ALT -HVAC
Climate Zones 10 to 15
Site Address:EnforcemeirtAgency:
1 1,R
Date:
Permit
I i • '
Conditioned Floor
E ui ment Type".
List Minimum Efficient Z
Duct insulation requirement
..Area
Thermostat
Packaged Unit
Furnace
E3AFUE
❑Q COP
Over 40 ft of ducts added or
Setback .
Coil
KISEERS
Q HSPF
replaced in unconditioned space
R 6 (CZ 10-13)
Served by system
?j
(1jnot already
be
9Indoor
Condensing Unit
EER
0 Resistance
-
R 8 (CZ 14-15)
sf
present, must
installed)
0ther
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -1 R -ALT -HVAC for each system.
2. Minimum Equipment Efficiencies: 13 SEER, 78% 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
sigAed. 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 replaced CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
CF -4R forms: MECH-21 and fors lits stems MECH-25
• Condenser Coil and /or • . •
an CF -6R forms:. MECH-2I-HERS and (for split systems) MECH-25-HERS
• Indoor Coil and
------- CF -4R forms: MECH-21 and (for split systems) MECH-25
• Furnace
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 f om duct leakage testing if:
I. 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 ducts stems are constructed, insulated or sealed with asbestos
2. New HVAC System
Required Forms:
• Cut in or Changeout with new
ducts: (all new ducting and all
CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS
new equipment)
CF -4R forms: MECH-20, and (for split systems) MECH-22, and MECH-25
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 Replacement Required Forms:
• Includes replacing or installing all new ducting CF -6R forms: MECH-04, MECH-20-14ERS,and (for split systems) MECH-25-HERS
and/or outdoor condensing unit and/or indoor CF -4R 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
linear feet of duct in unconditioned space.
CF -6R forms: MECH-04, MECH-2I-HERS CF -4R forms: MECH-21
For splits stem or packaged units: Duct leakage < 15 percent
EXCEPTION: Existing ducts stems 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 ofthe California Business and Professions Code to accept responsibility for the design identified on this Certificate of Compliance.
• 1 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 I and 6 of the California Code of Regulations.
n documented on other applicable compliance forms, worksheets,
• The design features identified on this Certificate of Compliance are consistent with the informVfixpermit
calculations, plans ands specifications submitted to the enforcement agency forapproval with appliotiQn.
Name: /
Signature:
Company:
Date:
2 I Zo l Z
Address: /
Zfl Y ISA Pt17C 0
License:
City/State/Zip:LA l ,125
Phone: -1 Lo - T11_7oI,'
(ENFQRCTAIIENT ,AGENCY
CAN:CUSTOMIZE WITH L'ETTERIEAD/SEAL)
2008 Building,Energy Effciency:Standards-Residential HVAC'Alterations Climate'
Zones 10 to 15'
BUSINESS AND PROFESSIONS CODE, SECTION 7110
Willful or deliberate disregard.and•violation of the building laws, including the California Building Code, and local permit
requirements constitutes a cause for disciplinary action from the Contractors State License Board working in conjunction with
the local building department. This action may consist of.fines up to $5,000 per violation or suspension/revocation of a
contractor's license.
WHEN IS A PERMIT REQUIRED?
A written construction permit shall be obtained from the enforcement agency prior to the erection, construction, reconstruction,
installation, relocation, or alteration of any mechanical system, except as permitted in Appendix Chapter 1, Section 112.2 of the 2007
California Mechanical Code. Projects requiring permits include, but are not limited to: `
• New HVAC installation Relocation of an existing HVAC unit
• HVAC Changeout Adding or replacing more than 40ft ducting
• Replacement of furnace, coil; FAU, or condenser in unconditioned space
2008 BUILDING ENERGY EFFICIENCY STANDARDS (Title 24, Part 6) REOUIREMENTS INCLUDE:
1. Heating equipment must have a minimum 78% AFUE (Exception: Wall & floor furnaces; room heaters).
2. Central air conditioners & heat pumps less than 65,000 Btu/hr must have a minimum 13 SEER.
3. Newly installed or replaced ducts must have a minimum insulation value of R-4.2. When more.than 40 ft of ducting will
be installed or replaced, the duct insulation value must be R-6 (CZ 10-13), or R-8 (CZ 14 and 15).
4. A setback type thermostat (24 hr clock with four set points) is required for all alterations.
5. New or replacement ducts must meet the mandatory requirements of Section 150(m):
• All joints and openings in the in the HVAC system must be sealed.
• Only UL 181, UL 181A, or UL 181B approved tapes or mastic shall be used to seal duct openings.
• Connections of metals ducts and the inner core of flex ducts shall be mechanically fastened. Flex ducts must be
connected using a metal sleeve/coupling.
• Flex ducts that are suspended must be supported every 4ft. max for horizontal runs with no more than 2" of sag
between supports and 6 ft. max for vertical runs.
WHEN IS HERS VERIFICATION REQUIRED AND WHAT FORMS ARE REQUIRED?
HERS verification is required for all HVAC alterations in Climate Zone 10-15. A HERS rater is a special inspector for the building
department. The building inspector may also request to be on site to witness testing by the contractor and/or HERS rater. The installer
picks one of the four options on the CF -1 R -ALT -HVAC Form that describe the work being conducted. Each option lists the forms
required to be at the job site for final inspection.
• CF -6R Forms shall be completed and submitted by the installing contractor for final inspection.`
• CF -4R Forms shall be completed, registered with an approved HERS Provider (cannot be completed by hand), and submitted
by the HERS Rater for final inspection effective January 1, 2010.
DESCRIPTION OF HERS TESTS BELOW (Full descriptions found in Residential Appendix RA3 and Residential Manual)
Duct sealing — The installer is to insure leakage of the HVAC system is less than 6% for new air conditioning system (new equipment
and all new ducts) or 15%, 60% reduction, seal all accessible leaks, etc. for alterations to existing HVAC systems. When the contractor
uses the option to seal all accessible leaks, all easily movable objects must be moved to seal existing ducting. New ducting installed by
the contractor is not allowed to have any leaks even if it is no longer accessible. In example 3 of the CF -1R "all new ducts" means that
all the ducting was changed. The original boots, plenums, etc. do not need to be changed.
Cooling Coil Airflow (CCA) — There are two different minimum air flow requirements that must be met. These are 300 CFM and 350
CFM. The minimum 300 CFM per ton of cooling is required in order to conduct a refrigerant charge test. For new HVAC systems
(new equipment and new ducts) the HVAC system must move a minimum 350 CFM of air for each ton of cooling.
Refrigerant Charge (RC) — The installer is required to verify the charge is correct. If the outside temperature is below 55 degrees
then the weigh in method must be used by the installer. When the weigh in method is used the HERS rater must retest when the
temperature is 55 and above. A charge indicator display (CID) can be used in place of conducting an RC, manufacturers are currently
developing this device.
Temperature Measurement Access Holes (TMAH) — Installer must drill and mark holes to measure temperature split.
Hole for the placement of a Static Pressure Probe (HSPP) or Permanently installed Static Pressure Probe (PSPP) — Either the
installer must drill and mark holes to measure static pressure or a permanently installed pressure probe must be installed and marked.
Saturation Temperature Measurement Sensors (STMS) — Permanently installed type K thermocouple are installed on the indoor
and outdoor coil so that the HERS rater can verify charge without attaching gauges. Instructions are found in Ch 4 of the Res. Manual.
Fan Watt Draw (FWD) — Installer verifies that the furnace fan watt draw is less than 0.58 Watts/CFM.
NOTE: The CF-6R-MECH-04 is required for all HVAC alterations.
* For Final inspection ALL compliance forms (CF -IRs, CF-6Rs, and CF-4Rs) shall be registered with an approved HERS
Provider for building permit applications submitted on or after October 1, 2010.
4
Bin. #.
City. of La Quinta
Building & Safety Division
P.O. Box 1504,'78-495 Calle Tampico
La.Wnta, CA 92253 -:(760) 777-7012
Building Permit Application and Tracking Sheet
Permit # j
Project Address: 12,O j i —i CD
Owner's Name:.
A P. Number.
Address: S•41'LCi E t
Legal Description: - - ► - 02,x
Contractor. LL AI
City, ST, Zip: .fil 3
Telephone: Y
Address:
Project Description: 64
City, ST, Zip:
e phone:
State Lie. # : City Lic. #;
Arch.; Engr., Designer
CQ%L-
C:
Address:
City., ST, Zip:
Telephone:
State Lic. M
Construction Type:. Occupancy:
Project type (circle one): Now Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.: # Stories: # Units:
Telephone # of Contact Person: M=- . '77 -7 B t S
Estimated Value of Project: 5Q(
APPLICANT: DO NOT WRITE BELOW THIS UNE
N Submittal Req'd Recd TRACKNG PERMITFEES
Plan Sets
Plan Check submitted
2 I
item Amount
structural Cafes.Reviewed,
ready for corrections
Plan Check Deposit. .
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Cates.
Plana picked up
Construction
Flood plain plan
Plans resubmitted
Mecharilcal
Giading plan
V Review, ready for correctionstissue
Electrical
Subeontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S M.L
11.0-A. Approval
Plans resubmitted
Grading
IN HOUSE:-
3" Review; ready for correctionsAssue
Developer Impact Fee
Planning Approval
Called Contact Person
Pub. Wks. Appr
Date of permit Issue
School Fees
Total Permit Fees
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-2S
Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of S)
Site Address: Enforcement Agency: Permit Number:
54120 AVE MADERO, La Quanta CA 92253 City of La Quinta 12-00000
Note: If installation of a Charge Indicator Display (CID) is utilized as an alternative to refrigerant charge verification for
compliance, a MECH-24 Certificate (instead of this MECH-25 Certificate) should be used to demonstrate compliance with
the refrigerant charge verification requirement. TMAH and STMS are not required for compliance, when a CID is utilized
for compliance.
As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional form(s) for
any additional systems in the dwelling as applicable.
Temperature Measurement Access Holes (TMAH) and Saturation Temperature Measurement
Sensors (STMS)
Procedures for installing TMAH are specified in Reference Residential Appendix RA3.2. If refrigerant charge verification is
required for compliance, TMAH are also required for compliance. STMS are only required for completely new or
replacement space -conditioning systems that utilize prescriptive compliance method.
TMAH - Access Holes In Supply and Return Plenums of Air Handler
System Name or Identification/Tag
System 1
System Location or Area Served
Whole House
1
® 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 Fail ✓ ® Pass I ✓ ❑ Fail
STMS - Sensos Qnthe, Evaporator Coil -
System Namq" or Ide , fication/Tag
;y istemZl; .
3
p les
The sensor is factory installed, or field installed according to manufacturer's
l7h dnsor is facto '7i sta ed, or field in all.ed ac ord ng to artufacturer's
specifications, ori in talt by hodT/specificat ons approv by the. Exlecutive
❑ Yes
❑ No
specifications, or is installed by methods/specifications approved by the Executive
D
k
Director.
rector..
4
p 1"es
p N•
The sensor wl e i termina w th a. s# nd'ard Urn plug suld ble for conn , cti orl o i
di,gi I(therMni74gr Theasens to €h Ili Ee`chniaia
❑ Yes
❑ No
digital thermometer. The sensor mini plug is accessible to the installing technician
r Mi'i pluglts accessible .
and the HERS rater without changing the airflow through the condenser coil
and the"HERS rater without changing the airflow through the conden?er 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
✓ ® 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 methods/specifications approved by the Executive
Director.
The sensor wire is terminated with a standard mini plug suitable for connection to a
7
❑ Yes
❑ No
digital thermometer. The sensor mini plug is accessible to the installing technician
and the HERS rater without changing the airflow through the condenser coil
8
❑ Yes
❑ No
When attached to a digital thermometer, the sensor provides an indication of the
saturation temperature of the coil.
Yes to 6, 7, and 8 is a pass. Enter N/A if STMS are not
✓ ® N/A
✓ ❑ Pass
✓ ❑ Fail
applicable. Otherwise enter Pass or Fail
a
Reg: 212-A0028039A-M2500001A-M25A Registration Date/Time: 2012/06/07 02:46:34 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-2!
Refrigerant Charge Verification - Standard Measurement Procedure (Page -2 of Sj
Site Address: Enforcement Agency: Permit Number:
54120 AVE MADERO, La Quinta CA 92253 1 City of La Quinta 12-00000
Standard Charge Measurement Procedure (for use if outdoor air dry-bulb is above 5S°F)
Procedures for determining Refrigerant Charge using the Standard Charge Measurement Procedure are available in Reference Residential
Appendix RA3.2. As many as 4 systems In the dwelling can be documented for compliance using this form. Attach an additional form(s) for
any additional systems in the dwelling as applicable.
The system should be Installed and charged in accordance with the manufacturer's specifications before starting this procedure.
• The system must meet minimum airflow requirements as prerequisite for a valid refrigerant charge test.
• If outdoor air dry-bulb is 55°F or below, the installer must use the Alternate Charge Measurement Procedure.
Space Conditioning Systems
System Name or Identifitation/Tag
System 1
(must be re -calibrated monthly)
Date of Th rmocoupl (Calibration
r;
#6/11L/12
System Location or Area Served
Whole House
Outdoor Unit Serial #
B4D100307197
Outdoor Unit Make
Maytag
Outdoor Unit Model
B4VM-X48K-3
Nominal Cooling Capacity Btu/hr
48000
Date of Verification
6/6/12
canoration or uiacmastic instruments
Date of Refrigerant Gauge Calibration
6/1/12
(must be re -calibrated monthly)
Date of Th rmocoupl (Calibration
r;
#6/11L/12
st b r-talibr ed monthly)
1•ICaSYfCu [:Cm eraLUrE75^I'Crt). LT. ®CA' AUNNO" 7 ,3W&P-:1M - Brrr waft, .2
System Name or Id n long
i ica
st
Syei[v i
Supply eva -ora"f'or
S1:Y
temperature (T )
supply, db
Return (evaporator entering) air dry-bulb
73.4
temperature (Tretum, db)
Return (evaporator entering) air wet -bulb
56.5
temperature (Treturn, wb)
Evaporator saturation temperature
40
(Tevaporator, sat)
.
Condensor saturation temperature
(Tcondensor, sat)
Suction line temperature (Tsuction)
47
Liquid Line Temperature (Tliquid)
Condenser (entering) air dry-bulb
96
temperature (Tcondenser, db)
1
P,
Reg: 212-A0028039A-M2500001A-M25A Registration Date/Time: 2012/06/07 02:46:34 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms March 2010
INSTALLATION CERTIFICATE CF-4R-MECH-2S
Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5)
Site Address: Enforcement Agency: Permit Number:
54120 AVE MADERO, La Quinta CA 92253 1 City of La Qui nta 12-00000
Minimum Airflow Requirement
Temperature Split Method Calculations for determining Minimum Airflow Requirement for Refrigerant Charge
Verification. The temperature split method is specified in Reference Residential Appendix RA3.2.
System Name or Identification/Tag
System 1
Calculate: Actual Temperature Split = Treturn,
22,20
db - Tsupply, db
Target Temperature Split from Table RA3.2-3
21.2
9
using Treturn, wb and Treturn, db
Calculate difference: Actual Temperature Split -
1
Target Temperature Split =
Passes if difference is between -4°F and +4°F or,
upon remeasurement, if between -4°F and
PASS
-100°F
Enter Pass or Fat
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)
A
System Na or Ide tfication/Tag
~fir t
fps t
Calculatlnimum Airfl Re vi m (GFM)
is
Ile
Measure 'Airfio Ysulg KA3 3ap'f eour s 1);
W
„ t
'
t
Passes if measured airflow is greater than or
equal to the calculated minimum airflow
requirement.
Enter Pass or Faill
Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used
for fixed orifice metering device systems
System Name or Identification/Tag
System 1
Calculate: Actual Superheat =
7.0
Tsuction - Tevaporator, sat
Target Superheat from Table RA3.2-2 using
10
Treturn, wb and Tcondenser, db
Calculate difference:
-3.00
Actual Superheat - Target Superheat =
System passes if difference is between -6°F and
+6°F
PASS
Enter Pass or Fail
0
Reg: 212-A0028039A-M2500001A-M25A Registration Date/Time: 2012/06/07 02:46:34 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
INSTALLATION CERTIFICATE CF-411-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of S)
Site Address: Enforcement Agency:. Permit Number:
54120 AVE MADERO, La Quinta CA 92253 City of La Quint a 12-00000
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 Superheat =
Calculate: Actual Subcooling =
Tsuction - Tevaporator, sat
Tcondenser, sat - Tli uid
Enter allowable superheat range from
Target Subcooling specified by manufacturer
manufacturer's specifications (or use range
Calculate difference:
specification is no available)
Actual Subcooling - Target Subcooling =
System pa se f actd (superheat thira e
System passes if difference is between
A10mr. Tkly
allowable u _erheat range"r
J,: P,
-4°F and +4°F
*Aant.P s ;br Fai
t
Enter Pass or Fai
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 no available)
System pa se f actd (superheat thira e
A10mr. Tkly
allowable u _erheat range"r
J,: P,
*Aant.P s ;br Fai
t
Reg: 212-A0028039A-M2500001A-M25A Registration Date/Time: 2012/06/07 02:46:34 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
INSTALLATION CERTIFICATE CF-4R-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page Sof 5)
Site Address: Enforcement Agency: Permit Number:
54120 AVE MADERO, La Quinta CA 92253 1 City of La Quinta 12-00000
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
874583
HERS Provider Data Registry Information
Sample Group # (if applicable): N/A ® tested/verified dwelling
System meets all refrigerant charge and airflow
a HERS sample group
HERS Rater Information CaICERTS Certificate # CCI -1798660517
HERS Rater Company Name:
requirements.
PASS
Responsible Rater's Signature:
Walter W Nellis
Walter W Nellis
Enter Pass or Fail
Date Signed: 6/6/2012
CC2004361
-7T -
"T
0
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 Certificates) of Compliance (CF -111) approved by the
enforcement agency.
Builder or Installer Information as shown on the Installation Certificate (CF -6111)
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
ALL ABOUT AIR
Responsible Person's Name:
CSLB License:
Roman Diaz
874583
HERS Provider Data Registry Information
Sample Group # (if applicable): N/A ® tested/verified dwelling
❑ not-tested/verified dwelling in
a HERS sample group
HERS Rater Information CaICERTS Certificate # CCI -1798660517
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: 6/6/2012
CC2004361
Reg: 212-A0028039A-M2500001A-M25A Registration Date/Time: 2012/06/07 02:46:34 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
INSTALLATION CERTIFICATE CF-611-MECH-04
Space Conditioning Systems, Ducts and Fans (Page 1 of 2)
Site Address: Enforcement Agency: Permit Number:
54120 AVE MADERO, La Quinta CA 92253 (System 1) City of La Quinti 12-00000
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 -IR.
value)4
Duct
Location
(attic,
crawl-
space,
etc.)
Duct
R -value
Heating
Load
(kBtu/hr)
Heating
Capacity
(kBtu/hr)
Split
_
1
(SEER
Location
Type
,. ,
and EER)
(attic,
(package:'
ARI
# of
1, 3
crawl-
Cooling
Cooling
gheat; "
GEC Certified Mfr..Natne> =
Reference
Identical
(>=CF -1R
space,
Duct
Load
Capacity
pumpp
and Model Numbei
Number2
Systems
value)4
etc.)
R -value
(kBtu/hr)
(kBtu/hr)
Split ...:
cooing cqurpmenr
i. lr protect is new construction; see footnotes to Standards Table 151-B and Table 151-C for duct ceiling alternative
compliance:
2. ARI Reference Number can, vf and by entering the equipment model number at
http://www.aridirectory.orgla,. c:php#
3. Listed efficiency on this page must be greater than or equal ( ? ) to the value shown on the CF -11? form.
4. When CF -1R is reference it is also applicable to the CF -1R, CF -1R -AA or CF -IR -ALT .
ALL BOXES MUST BE CHECKED TO BE A VALID FORM
El §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).
® §150(j)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: 212-A0028039A-M0400001A-0000 Registration Date/Time: 2012/05/31 22:43:54 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms August 2009
S I
Efficiency
Duct.
Equip
_
(SEER
Location
Type
,. ,
and EER)
(attic,
(package:'
ARI
# of
1, 3
crawl-
Cooling
Cooling
gheat; "
GEC Certified Mfr..Natne> =
Reference
Identical
(>=CF -1R
space,
Duct
Load
Capacity
pumpp
and Model Numbei
Number2
Systems
value)4
etc.)
R -value
(kBtu/hr)
(kBtu/hr)
Split ...:
Heat"Pump;
#
f
r r, 1j+
Al
o'
„R
l .. 1
.,yn R $ 31 -^ 4 i
•
i`"Z ,;..n
i
, .ay,yt.r
S . . __.,
'may''
rQ d
• _. T
%i
n
, yx f
i. lr protect is new construction; see footnotes to Standards Table 151-B and Table 151-C for duct ceiling alternative
compliance:
2. ARI Reference Number can, vf and by entering the equipment model number at
http://www.aridirectory.orgla,. c:php#
3. Listed efficiency on this page must be greater than or equal ( ? ) to the value shown on the CF -11? form.
4. When CF -1R is reference it is also applicable to the CF -1R, CF -1R -AA or CF -IR -ALT .
ALL BOXES MUST BE CHECKED TO BE A VALID FORM
El §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).
® §150(j)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: 212-A0028039A-M0400001A-0000 Registration Date/Time: 2012/05/31 22:43:54 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms August 2009
INSTALLATION CERTIFICATE CF-611-MECH-04
Space Conditioning Systems, Ducts and Fans (Page 2 of 2)
Site Address: Enforcement Agency: Permit Number:
54120 AVE MADERO, La Quinta CA 92253 (System 1) City of La Quinta 12-00000
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 r/4 inch, the combination
of mastic and either mesh or tape shall be used; and
® 1. Build Ing'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 thas water retardant and provides shielding from solar radiation that can cause
.-degradation-ofthe material'V' ,:
I, Flexible ducts cannot'' have.: porous inner cores.
.v v -_' f' #' a., v.- ""` ' 7``Pr`": •*.* tf. t , .X '". :.. '* kaxv YWsrt`,_ vx' k^: `.^<- sa•
DEC LARATIOWSTATEMENT
. I'cgrtlfy under penatty.pf;
aperjury, nd&,` he laws of the State of California, the information provided on this form is true and correct. .
. I m :eligible'underDivWon,3 of the 9'uslness and Professions Code to accept responsibility for construction, or an authorized
representative of the person':respons(ble for construction (responsible person).
. I certify that the installed f06Wiresjjiiit4rlaIs, components, or manufactured devices identified on this certificate (the Installation)
conforms to all applicable codesandre9ulations, 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 -1R) 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)
All About Air
Responsible Person's Name:
Responsible. Person's Signature:
Roman Diaz
Roman bioz
CSLB License:
Date Signed:
Position With Company (Title):
874583
4/26/2012
Reg: 212-A0028039A-M0400001A-0000 Registration Date/Time: 2012/05/31 22:43:54 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms August 2009
INSTALLATION CERTIFICATE* CF-6R-MECH-2S-HERS'
Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of S)
Site Address: Enforcement Agency:Permit Number:
54120 AVE MADERO, La Quinta CA 92253 City of La Quinta 12-00000
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 cavi be documented for compliance using this form. Attach an additional form(s) for
any additional systems in the dwelling as applicable.
Temperature Measurement Access Holes (TMAH) and Saturation Temperature Measurement
Sensors (STMS)
Procedures for installing TMAH are specified in Reference Residential Appendix RA3.2. If refrigerant charge verification is
required for compliance, TMAH are also required for compliance. STMS are only required for completely new or
replacement space -conditioning systems that utilize prescriptive compliance method.
TMAH - Access Holes In Supplv and Return Plenums of Air Handler
System Name or Identification/Tag System 1
System Location or Area Served
Whole House
1
® Yes
❑ No
The sensor is f4cto.rt installed,?or field it talled a' rdiflg to: ahufa Urers
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
'
L;
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 i:and.2 is,a pa"ss;•;
T`e'a; Enter Pass or Fail ✓ ® Pass ✓ ❑ Fail
STMS =. Sensor on the Evaporator Coil ,1_,,
System'Nag)"r"Iden tification/Tag
4,olf, _, .' Ystem;t
'
6
The sensor is f4cto.rt installed,?or field it talled a' rdiflg to: ahufa Urers
3
specifications, or is installed by methods/specifications approved by the Executive
_
apbcificafions, or i insta 1 by etho /specifica ons approv _ by the E ecuti e
' .
Director.
Director. . h ..r .
4
Y
7Vd
T terminated. ath a,Standard"Hnl plug su able fpr con ecfon xt
d tal'tber otne er. Thg senspr mini"p`lug is ai cgssible tortheJ t lling gc nii
❑ No
digital thermometer. The sensor mini plug is accessible to the installing technician
and
and the HERS rater without changing the airflow through the condenser coil
8
the HE S:rater without'cl tinging the, airflow through the: condenser cosh'
5
p Yes
❑ No .:::
The sensor.measures the saturation temperature of the coil within 1.3 degrees F
Yes to3,4,_and'5,Is a&pass: Ent1.er N/A. if STMS are not
applicable. Ottier,wtse enter_Pass o Fail'
✓ ® N/A
I
✓ [3 Pass
I
✓ ❑ Fail
STMS - Sensor on the Condens' r Coil
System Name or Identification/Tag,. j . System 1
The sensor is factory installed, or field installed according to manufacturer's
6
❑ Yes
❑ No
specifications, or is installed by methods/specifications approved by the Executive
Director.
The sensor wire is terminated with a standard mini plug suitable for connection to a
7
❑ Yes
❑ No
digital thermometer. The sensor mini plug is accessible to the installing technician
and the HERS rater without changing the airflow through the condenser coil
8
❑ Yes
❑ No
IThe sensor measures the saturation temperature of the coil within 1.3 degrees F
Yes to 6, 7, and 8 is a pass. Enter N/A if STMS are not
✓ ®N/A
✓ [I Pa
✓ ❑Fail
applicable. Otherwise enter Pass or Fail
Reg: 212-A0028039A-M2500001A-0000 Registration Date/Time: 2012/05/31 22:51:03 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms August 2009
INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS
Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5)
Site Address: Enforcement Agency: Permit Number:
54120 AVE MADERO, La Quinta CA 92253 1 City of La QL 1 12-00000
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 RA3.1. As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional form(s) fur
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 alrflow 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 Change Measurement Procedure.
Space Conditioning Systems
System Name or Identification/Tag
System 1
onthly)
(must be re -calibrated monthly),,]
C -
Date of.Thet7nocoupl ChHbration .
".:. ` 4J1$%201k+#
System Location or Area Served
Whole House
Outdoor Unit Serial #
PSD070500675
Outdoor Unit Make
MAYTAG
Outdoor Unit Model
PSH4BE048K
Nominal Cooling Capacity Btu/hr' i,
48000
Date of Verification fy
4/26/2012
Lmipration or,wagnOstic.instruments
Date of Refrigerant' Gauge Calibration
4/15/2012
onthly)
(must be re -calibrated monthly),,]
C -
Date of.Thet7nocoupl ChHbration .
".:. ` 4J1$%201k+#
tr
ur'.-tallbrded monthly)
,
Measurga iemperature , ! ., 1 fir, I
F _77 5
System ami or Id icati on/T gAV `-
y em 1
r
,
Supply (evapot-9to Jdaving) air tiry*bulb
y 54
temperature (T supply, db) , r
r a .,, ,
Return (evaporrato(;entermg) air dry -bulli
76
tern raturei(Tretum db)'::
Return (evaporator entering) air Wet bulb
60
temperature (Treturn, wb)t .I ''
Evaporator saturation temperatur4`
44
(Tevaporator, sat)
Condensor saturation temperature
(Tcondensor, sat)
Suction line temperature (Tsuction)
54
Liquid Line Temperature (Tliquid)
Condenser (entering) air dry-bulb
88
temperature (Tcondenser, db)
Reg: 212-A0028039A-M2500001A-0000 Registration Date/Time: 2012/05/31 22:51:03 HERS Provider: Ca10ERTS, 'Inc.
2008 Residential Compliance Forms August 2009
:NSTALLATION CERTIFICATE CF-6R-MECH-25-HER:
tefrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5
Site Address: Enforcement Agency: Permit Number:
54120 AVE MADERO, La Quinta CA 92253 1 City of La Quinta 12-00000
Minimum Airflow Requirement
Temperature Split Method Calculations for determining Minimum Airflow Requirement for Refrigerant Charge
Verification. The temperature split method is specified in Reference Residential Appendix RA3.2.
System Name or Identification/Tag
System 1
Calculate: Actual Temperature Split = Treturn;
22.00
db - Tsupply, db
Target Temperature Split from Table RA3.2-3
19.2
using Treturn, wb and Treturn, db
13.7
Calculate difference: Actual Temperature Split -
2.8
Target Temperature Split =
l'
Passes if difference is between -3°F and +3°F or,
upon remeasurement, if between -3°F and
PASS
-100°F
Enter Pass or Faill
Note: Temperature Split Method Calculation is not necessary if actual Cooling Coil Airflow is verified using one of the
airflow measurement procedures specified in Reference Residential Appendix RA3.3. If actual cooling coil airflow is
measured, the value must be. equal to or greater than the Calculated Minimum Airflow Requirement in the table below.
Calculated Minimum Airflow Requirement (CFM) = Nominal Cooling Capacity (ton) X 300 (cfm/ton)
System Na"
y n' e or Iderljification/Tag
" _, $ystent" ,
i .
Calculat d Minimum Ai equi ement (CFM)
R ti..
Measuredlprflow.d r g RA1.3 procedur (CFMa r.
'; .• '
-
1 - I
Passes if measured airflo. w is greater' than or
equal to the calculated"minimum airflow
requirement ' `
Enter Pass or Faill
Superheat Charge Methgd'Calculations for Refrigerant Charge Verification. This procedure is required to be used
for fixed orifice metering device systems
System Name or Identification/Tag
System 1
Calculate: Actual Superheat =
10.0
Tsuction - Tevaporator, sat
Target Superheat from Table RA3.2-2 using
Treturn, wb and Tcondenser, db
13.7
Calculate difference:
-3.70
Actual Superheat - Target Superheat =
l'
System passes if difference is between -5°F and
+5°F
PASS
Enter Pass or Fail
Reg: 212-A0028039A-M2500001A-0000 Registration Date/Time: 2012/05/31 22:51:03 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms August 2009
INSTALLATION CERTIFICATE CF-611-MECH-25-HERS
Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5)
Site Address: Enforcement Agency: Permit Number:
54120 AVE MADERO, La Quinta CA 92253 ---TCity of La Quinta 12-00000
Subcooling Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used
for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems.
System Name or Identification/Tag
System 1
Calculate: Actual Subcooling =
Tcondenser, sat - Tliquid
Target Subcooling specified by manufacturer
Calculate difference:
Actual Subcooling - Target Subcooling =
System passes if difference is between
-3°F and +3°F
a5
-
r
Enter Pass or Fail
Metering Device Calculations for Refrigerant Charge Verification. This procedure is required to be used for
thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems.
System Name or Identification/Tag.
System 1
Calculate: Actual Superheat
Tsuction - Tevaporator, sat
Enter«allowable superheat range froafn,
manufacturers specifications (or use range
between 4'F an`if
d.25°Fmanufactuter's •.
specification is not available)
System passes If'aet4 1'superheat i ithl
a5
-
r
allowabld,96perheat-range >
gte Pass of Fai
Reg: 212-A0028039A-M2500001A-0000 Registration Date/Time: 2012/05/31 22:51:03 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms IAugust 2009
INSTALLATION CERTIFICATE CF-611-MECH-25-HERS
Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5)
Site Address: Enforcement Agency: Permit Number:
54120 AVE MADERO, La Quinta CA 92253 City of La Quinta 12-00000
Standard Charge Measurement Summary:
System shall pass both refrigerant charge criteria, metering device criteria (if applicable), and minimum cooling coil
airflow criteria based on measurements taken concurrently during system operation. If corrective actions were taken, all
applicable verification criteria must be re -measured and/or recalculated.
System Name or Identification/Tag
System 1
CSLB License:
874583
Date Signed:
4/26/201.2
Position With Company (Title):
System meets all refrigerant charge and airflow
Name of TPQCP (if applicable):
Control Program (TPQCP)? p Yes p No
requirements.
PASS
Enter Pass or Fail
r
DECLARATION STATEMENT
• I certify under penalty of perjury, und& 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 .OaSlness 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, ffiaterials, 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 fall to meet the requirements of such quality assurance checking, the required corrective action and
additional checking/testing of other installations in that HERS sample group will be performed at my expense.
• I reviewed a copy of the Certificate of Compliance (CF -111) form approved by the enforcement agency that identifies the specific
requirements for the installation. I certify that the requirements detailed on the CF -111 that apply to the Installation have been met.
. I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the
building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I
understand that a signed copy of this Installation Certificate Is required to be included with the documentation the builder
provides to the building owner at occupancy. I will ensure that all Installation Certificates will come from a HERS provider data
registry for multiple orientation alternatives. and beoinnina Oetoher 1. 7010fnr all Inw-rice+ rPcldPntinl hnliriinnc
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
All About Air
Responsible Person's Name:
Responsible Person's Signature:
Roman Diaz
Roman Diaz
CSLB License:
874583
Date Signed:
4/26/201.2
Position With Company (Title):
Is this installation monitored by a Third Party Quality
Name of TPQCP (if applicable):
Control Program (TPQCP)? p Yes p No
Reg: 212-A0028039A-M2500001A-0000 Registration Date/Time: 2012/05/31 22:51:03 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms August 2009