MECH (12-1246)P.O. BOX 1504
78-495 CALLEJAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
-12-00001246-
Property Address:
52445 AVENIDA NAVARRO
APN: -
773-274-020-9 -000000-
Application description:
MECHANICAL
Property Zoning:
COVE RESIDENTIAL
Application valuation:
4900
Tiht 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
STACY FITSIMMONS
52445 AVENIDA NAVARRO
LA QUINTA, CA 92253 '
VOICE (760) 77
FAX (760) 777 -
INSPECTIONS (760) 777-7153
Date: 10/18/12
LM
Contractor: D U
Applicant: Architect or Engineer: PREC H & A INC OCT 18 ZO12
P.O.-BOX 11090
PALM DESERT, CA 92255
(760) 776-1550 CITY OF LA QUINTA
Lic. No.: 818759 FINANCE DEPT
-------------------------
• LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
Lic se Clas C 0 C36 q License No.: 818759 for by Section 3700 of the Labor Code, for the performance of'the work for which this permit is
C ,/ /,�///moi _ 1`Y' issued.
Date: �U�d"ontractor. / ✓—��7G`r� - Y` 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
OWNER -BUILDER DECLARATION- insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier TRUCK INS EXCHN Policy Number N 2008 71 19
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to _ 1 certify that, in the performance of the work for which this permit is issued, I shall 'not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to become subject 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 ecome 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 3/00 oft Labo od8/shall foythwith comply with those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by / 7J��
any applicant for a permit subjects. the applicant to a civil penalty of not more than five hundred dollars ($500).: te: /G ` plicant:
(_) 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 WARNING: FAIL RE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN -
improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION'3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
one year of completion, the owner -builder will have the burden of proving that he or she did not build or
improve for the purpose of sale.). -
(_) 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,improvesthereon, and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
( ) I am exempt under Sec. , BAP.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name: n
Lender's Address: C
LQPER 11T
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
conditions and restrictions set forth on this application.
1. Each person upon whose behalf this application is made, each person at whose request and for
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quinta, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work is not commenced
within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the above information is correct. I agree to comply with all
city aWcountto
ances and state laws relating to building construction and hereby authorize representatives
ofthisr upon the above-mentioned property nspeccttion urposes.
Oate:nature (Applicant or Agent):��f .
Application Number 12-00001246
Permit MECHANICAL
Additional desc
Permit Fee . . . . 40.50
Plan Check Fee
10.13
Issue Date . . . .
Valuation
0
Expiration Date 4/16/13
Qty Unit Charge Per
Extension
BASE
FEE
15.00"
1.00 9.0000 EA MECH
FURNACE <=100K
9.00
1.00 16.5000 EA MECH
B/C >3-15HP/>100K-500KBTU
16.50
-----------------------------------------------------------------------------
Special Notes and Comments
HVAC CHANGE -OUT: CHANGE OUT HEAT
PUMP,
SPLIT SYSTEM, FURNACE & CONDENSER.
2010
CODES.
-------------------------------------------------- ---------
-----
OtherFees .. . . . . BLDG STDS ADMIN (SB1473)
Other Fees
7 -----------
1.00
Fee summary Charged
----------
Paid Credited c.
--------------------
Due
---------------------------
Permit Fee Total 40.50
00 .00
40.50
Plan Check Total 10.13
.00 .00
10.13
Other Fee Total 1.00
00 .00
1.00
Grand Total 51.63
.00 .00
51:63
LQPERMIT
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -IR -ALT -HVAC
Climate Zones 10 - 15
Site Address: iiiiiiiiiiiiiiiiiIiiiiiiiiii�Enforcement
Agency:
Date:
Permit #:
52445 Avenida Navarro La Quinta, CA 92253
City of La Quinta
Oct 17, 2012
Duct insulation
Conditioned Floor
Equipment Typel
List Minimum Efficiency2
requirement
Area
Thermostat
❑ Package Unit
® Furnace
❑ Indoor Coil
❑ AFUE
I@ SEER 13.0
❑ COP
Ili HSPF 7.7If
❑ R 6 (CZ 10-13)
Served by system
® Setback
not already present, must be
I@ Condensing Unit
[3 EER
[I Resistance
[1 R 8 (CZ 14-15)
1600 sf
installed)
❑ Other
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -IR -ALT -HVAC for each system.
2. Minimum Equipment Efficiencies: 13 SEER, 78% AFUE, 7.7HSPF for typical residential systems.
HERS VERIFICATION SUMMARY Listed below are FOUR HVAC alteration Options. The installer decides what work is being done
and picks one of the appropriate Options. Each Option lists the HERS measures that must be conducted. A copy of the forms shall
be left on site for final inspection and a copy given to the homeowner. At final, the inspector verifies that the work listed on this
form was in fact the work completed by the installer. The inspector also verifies that each appropriate CF -6R and registered CF -41R
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 -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
replaced
CF -4R forms: MECH-21 and (for split systems) MECH-25
. Condenser Coil and /or
CF -6R forms: MECH-04, 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
. Furnace
For Split Systems: Duct leakagei< 15 percent; RC, CCA 5 300 CFM/ton (Minimum Air Flow Requirement), TMAH
o....kaged Units- n,.rl l,. -,i aop 4 15 '
For- perGeet
Exempted from duct leakage testing
[1-1. Duct system was documented to have been previously sealed and confirmed through HERS verification, or
❑ 2. Duct systems with less thin 40 linear feet in unconditioned space, or
❑.3. Existing duct systems are constructed, insulated or sealed with asbestos
❑ 4. The system will not be Duct d'(ie DuctlesslMini-Spht;System)i,(AlsoiEx empt fromrRefrigerant Charge)
1:12. New;:H_ VAC System
Re uired
q ;amu,._ �,. ". � .. • � .e_ .�. � _' ?,'-e � _...,, f -
. Cut mtor'Chengeout with,
�W ,Bk, s 3;:, �, 4
v
CF -6 forms MECH-04, MECH=20 HERS, and (for split systems) MECH-22 HERS, and k -
new ducts:p(all new J, "
ducting and all new '
MECH=25;HERS i`
ioir MECH and MECH=25 `
equipment) "
CF'4R 20, and (for split systems)1MECH-22 ,mgr
�w.�g
For Split Systems:'Duct leakage<,;6 percent, RC,4CCA > 350 CFM/ton FWD, TMAH,,STMS, and either HSPP of PSPP. '
For Packaged Units: Duct leakagEL,. �6`percent
❑ 3. New•Ducts with/or without ri .•
Required Forms:
Replacement - -`• _. V.
. Includes replacing or installing aWnew
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
lRequired Forms:
. Includes adding or replacing more than 40
CF -6R forms: MECH-04,-MECH-2I-HERS
linear feet of duct in unconditioned space.
CF -4R forms: MECH-21
For split system or packaged units: Duct leakage < 15 percent
❑ EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos.'
Contractor (Documentation Author's /Responsible Designer's Declaration Statement)
. I certify that this Certificate of Compliance documentation is accurate and complete.
. I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of
Compliance.
. I certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the
requirements of Title 24, Parts 1 and 6 of the California Code of Regulations.
. The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance
forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with the permit application.
Name: Gerald Dobbins Signature: Gerald Dobbins
Company: PREC H & A INC Date: Oct 17, 2012
Address: P 0 BOX 10991 License: 818759
City/State/Zip: PALM DESERT / CA / 92255 Phone: (760) 776-1550
Reg: 212-A0058091A=000000000-0000 Registration Date/Time: 2012/10/17 17:33:53 HERS Provider: CaICERTS, Inc.
2008 Residential Compliance Forms July 2010
V
i
Bin. #
City 0 ' La Quinta
Building 8L Safety Division
Permit # P.O. Box 1504,78-495 Calle Tampico
��
La.Quinta, CA 92253 - (760) 777-7012
I I Permit
Building Application and Tracking Sheet
Project Address: Owner's Name:. S " S
A P. Number. Address:
Legal Description: City, ST, Zip: l 3
Contractor. /i�f(/ y/ Telephon % 6q- elza ` s �z `w's-
:.:,
M
Address:Project Description:
City' ST. Zip.
i G Q s�
i
Telephone:
State Lic. # : City Lic. #:
Arch En gr., Designer:
Address:
City., ST, Zip:
Telephone: Construction Type: Occupancy:
State Lic. #: 7 Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: Sq. Ft: #Stories: #Units:
Telephone # of Contact Person: Estimated Value of Project
APPLICANT: DO NOT WRITE BELOW THIS UNE
# Submittal Req'd 'Reed TRACKING PERMIT FEES'
'
Plan Sets Plan Check submitted Item Amount
Structural Calm Reviewed, ready for corrections Plan Check Deposit. .
Truss Calcs. Called Contact Person Plan Check Balance
Title 24 Cal& Plans picked up Construction
'
---
—-Pians-resubmitted.. —
N Flood plain plan -Mechanical
Grading plan
2'' Review, ready for correctioaslissue
Electrical
Subeontactor List
Called Contact Person
Plumbing -
Grant Deed
Plans picked up
S.M.L
H.O A Approval
Plans resubmitted
Grading
IN FiOUSE:-
'id Review, ready for correctionsPrssue
Developer Impact Fee
Planning Approval-
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit Issue
School Fees '
Total Permit Fees
11 4i
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING
CF-4R-MECH-21
Duct Leakage Test — Existing Duct System
(Page 1 of 2)
Site Address:
52445 Avenida Navarro, La Quinta CA 92253 (System
Enforcement Agency:
Permit Number:
1)
City of La Quinta
12-00001246
Enter the Duct System Name or Identification/Tag: System 1
Enter the Duct System Location or Area Served: Whole House
Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the
dwelling.
This installation certificate is required for compliance for alterations and additions in existing dwellings to
space conditioning systems and duct systems.
Note: For existing dwellings, a completely new or replacement duct system can also include existing parts of
the original duct system (e.g., register boots, air handler, coil, plenums, etc.) if those parts are accessible
and they can be sealed. For a completely new or replacement duct system installed in an existing dwelling,
use the Installation Certificate titled "Duct Leakage Test - Completely New or Replacement Duct System. "
Duct Leakage Diagnostic Test - existina 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 Qptions 1, 2, or 3 must be-attempted,,before„utilizing Option4.)_ ;
Determine nominal Fatn-Flow using one ofTthe following three,:calculationmethods
✓®Cooling system method:Size of;condenser in Tons 4 x400 =1 1600 CFM i
✓ ❑ Heating system method: 21 7 z' Output Capacrty.inThousands of Btu/hr— .r CFM
✓ ❑Measured system airflow using RA3 3 airflow4est CFM
procedures _
f
Option 1 used then`.
1
Allowed leakage = Fan Flow 1600 x0.15 = 240 CFM
Actual Leakage.= 221 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
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:
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
Reg: 212-A0058091A-M2100001A-M21A Registration Date/Time: 2012/10/25 15:04:32 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
4
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING
CF-4R-MECH-21
Duct Leakage Test — Existing Duct System
(Page 2 of 2)
Site Address:
52445 Avenida Navarro, La Quinta CA 92253 (System
Enforcement Agency:
Permit Number:
1)
City of La Quinta
12-00001246
® 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 supply, and return register`boots'must be, sealed to the drywall if smoke tests utilized for compliance
- applies`to duct leakage,.compliance option 3 (leakage reduction by.,,60%) and option 4t.(fix all accessible
leaks) described above -'
® New duct installations -cannot utilize building cavities as plenums'or platform returns in lieu of ducts
® Mastic and draw bands must be used in combination with cloth backed rubber adhesive duct Pape 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 -111) 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 Name: (Installing Subcontractor or General Contractor or Builder/Owner)
PREC H & A INC
Responsible Person's Name:
CSLB License:
Gerald Dobbins
1818759
HERS Provider Data Registry Information
Sample Group # (if applicable): N/A
® tested/verified dwelling
❑ not-tested/verified dwelling in
la
HERS sample group
HERS Rater Information CaICERTS Certificate # CC1-1798700276
HERS Rater Company Name:
Eddie Hernandez Jr
Responsible Rater's Name:
Responsible Rater's Signature:
Eddie Hernandez, Jr.
Eddie Hernandez, Jr.
Responsible Rater's Certification Number w/ this HERS Provider:
Date Signed: 10/25/2012
CC2004518
Reg: 212-A0058091A-M2100001A-M21A Registration Date/Time: 2012/10/25 15:04:32 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
G
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 5)
Site Address: Enforcement Agency: Permit Number:
52445 Avenida Navarro, La Quinta CA 92253 [City of La Quinta 12-00001246
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
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_-onAhe,Evaporator'CoiU"
System Narrib or Identification/Tag 7; : f System 1
a
The sensor is factory -installed, or�field installed according to manufacturer's .
3
❑Yes
psNo 'specifications,
or is installed by methods/specification approved by,the Executive
1
Director.
The sensor wire is terminated with a standard mini plug suitable for connection to a:
4
:Q Yes ... `
❑:No
_ ,
digital4ther'mometer. The sensor mini'plug is accessible to the'Jnstalling technic an
and the�HERS rater 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.
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
Reg: 212-A0058091A-M2500001A-M25A Registration Date/Time: 2012/10/25 15:06:39 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms March 2010
i
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5)
Site Address: Enforcement Agency: Permit Number:
52445 Avenida Navarro, La Quinta CA 92253 1 City of La Qu 1 12-00001246
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 Conditioning Systems
System Name or Identification/Tag
System 1
(must be re -calibrated monthly)
Date of TherrliocoupledCalibra tion d
{, 10/1%2012 Ff
System Location or Area Served
Whole House
_.
Outdoor Unit Serial #
7692W291212267
-r
Outdoor Unit Make
Rheem
Outdoor Unit Model
133PL48A0I
Nominal Cooling Capacity Btu/hr
48000
Date of Verification
10/25/2012
calloratlon or magnostic instruments
Date of Refrigerant Gauge Calibration
10/1/2012
(must be re -calibrated monthly)
Date of TherrliocoupledCalibra tion d
{, 10/1%2012 Ff
(must be re -calibrated monthly)
_.
Measureo'iemperatures-1,"r1 t ;
System Name or Ident fication/Tag
System i
Supply (evaporator leavi,ng).air dry-bulb.
-r
temperature (T )
supply, db
Return (evaporator'entering) air dry-bulb
temperature (Treturn, db)
Return (evaporator entering) air wet -bulb
75
temperature (Treturn, wb)
Evaporator saturation temperature
38
(Tevaporator, sat)
Condensor saturation temperature
(Tcondensor, sat)
Suction line temperature (Tsuction)
48
Liquid Line Temperature (Tliquid)
Condenser (entering) air dry-bulb
75
temperature (Tcondenser, db)
Reg: 212-A0058091A-M2500001A-M25A Registration Date/Time: 2012/10/25 15:06:39 HERS Provider: Ca10ERTS, 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 Agency: Permit Number:
52445 Avenida Navarro, La Quinta CA 92253 City of La Quinta 12-00001246
Minimum Airflow Reauirement
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,
db - Tsupply, db
10.0
Target Temperature Split from Table RA3.2-3
using Treturn, wb and Treturn, db
10
Calculate difference: Actual Temperature Split -
0.00
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 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 Mme or Identification/Tag I
System 1, 3
Calculated Minimum Airflow Requirement (CFM)
1 1200
Measured -Airflow sing RA3�3 procedures.(GEM)��
1512�
Passes if measured airflow is greater, than or
equal to the calculated minimum airflow
PASS
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
System 1
Calculate: Actual Superheat =
Tsuction - Tevaporator, sat
10.0
Target Superheat from Table RA3.2-2 using
Treturn, wb and Tcondenser, db
10
Calculate difference:
0.00
Actual Superheat - Target Superheat =
System passes if difference is between -6°F and
+6°F
PASS
Enter Pass or Faill
Keg: -d1L-AuuS8091A-M2500001A-M25A Registration Date/Time: 2012/10/25 15:06:39 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
INSTALLATION CERTIFICATE CF-4R-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5)
Site Address: Enforcement Agency: Permit Number:
52445 Avenida Navarro, La Quinta CA 92253 1 City of La Quinta 12-00001246
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
i
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)
Systemp
p asses,if actual.su erheat is.;within'the
i
allow, bleuperheat range�
r •-� Enter,Pass or Fail
z
Reg: 212-A0058091A-M2500001A-M25A Registration Date/Time: 2012/10/25 15:06:39 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
INSTALLATION CERTIFICATE CF-4R-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5)
Site Address: Enforcement Agency: Permit Number:
52445 Avenida Navarro, La Quinta CA 92253 [city of La Quinta 12-00001246
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
1818759
HERS Provider Data Registry Information
Sample Group # (if applicable): N/A
System meets all refrigerant charge and airflow
❑ not-tested/verified dwelling in
la
HERS sample group
requirements.
PASS
Eddie Hernandez Jr
Responsible Rater's Name:
Responsible Rater's Signature:
Enter Pass or Fail
Eddie Hernandez, Jr.
Responsible Rater's Certification Number w/ this HERS Provider:
Date Signed: 10/25/2012
CC2004518
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 -IR) 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 -1R) 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)
PREC H & A INC
Responsible Person's Name:
CSLB License:
Gerald Dobbins
1818759
HERS Provider Data Registry Information
Sample Group # (if applicable): N/A
® tested/verified dwelling
❑ not-tested/verified dwelling in
la
HERS sample group
HERS Rater Information CalCERTS Certificate # CC1-1798700276
HERS Rater Company Name:
Eddie Hernandez Jr
Responsible Rater's Name:
Responsible Rater's Signature:
Eddie Hernandez, Jr.
Eddie Hernandez, Jr.
Responsible Rater's Certification Number w/ this HERS Provider:
Date Signed: 10/25/2012
CC2004518
Reg: 212-A0058091A-M2500001A-M25A Registration Date/Time: 2012/10/25 15:06:39 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms March 2010
Space Conditioning Systems
Heating Eauiament
Equip
Type
(package-
heat pump)
'
INSTALLATION CERTIFICATE CF-6R-MECH-04
# of
Identical
Systems
Space Conditioning Systems, Ducts and Fans (Page 1 of 2)
Duct
Location
(attic,
crawl-
space,
etc.)
Site Address:
52445 Avenida Navarro, La Quinta CA 92253 (System
1)
Enforcement Agency:
City of La Quinta
Permit Number:
12-00001246
Space Conditioning Systems
Heating Eauiament
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)
Split
Heat Pump
Carrier
FB4CNF048
ARI
1
and EER)
1, 3
Attic
R-4.2
44
4 Tons
heat
CEC Certified Mfr. Naine:A,:
Reference
Identical
(>=CF -1R
space, -
Duct
Load -
Capacity
pump)
and Model Number '1 : •
Number2
Systems
value)4
etc.)
R -value
(kBtu/hr)
(kBtu/hr)
Split
Heat Pump,
. Rheem
.',13P]L48A01 *{p1,
c�
a ,�a
' }{13
SEER;
Atticw
R 4.2 _' ;
; X44
4 Tons
Equip
Efficiency
(SEER
Duct
Location
Type..
(package
"" .� .
ARI
# of
and EER)
1, 3
(attic,
crawl-
Cooling
Cooling
heat
CEC Certified Mfr. Naine:A,:
Reference
Identical
(>=CF -1R
space, -
Duct
Load -
Capacity
pump)
and Model Number '1 : •
Number2
Systems
value)4
etc.)
R -value
(kBtu/hr)
(kBtu/hr)
Split
Heat Pump,
. Rheem
.',13P]L48A01 *{p1,
c�
a ,�a
' }{13
SEER;
Atticw
R 4.2 _' ;
; X44
4 Tons
1 If
project hs new construction, see..Footnotes to Standards Table 151-8 and Table 151-C for duct ceiling alternative
compliance.
2. ARI Reference Number can be' found by entering the equipment model number at
http://www. aridirectory. 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 -1R 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).
® §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.
e _
,
Meg: z1e-AUUbdUy1A-M0400001A-0000 Registration Date/Time: 2012/10/25 15:00:02 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms ', August 2009
INSTALLATION CERTIFICATE CF-6R-MECH-04
Space Conditioning Systems, Ducts and Fans (Page 2 of 2)i
Site Address:
52445 Avenida Navarro, La Quinta CA 92253 (System Enforcement Agency: Permit Number:
1) City of La Quinta 12-00001246
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
d u cts.
® 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.
® B. 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.•
010. Flexibl.erclucts cannot have porous inner. 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.
. 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized
representative of the person responsible for construction (responsible person).
. I certify that the installed features,- materials, components, or manufactured devices identified on this certificate (the installation)
conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the
enforcement agency.
. I reviewed a copy of the Certificate of Compliance (CF -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)
PREC H & A INC
Responsible Person's Name:
Responsible Person's Signature:
Gerald Dobbins
Gerald Dobbins
CSLB License:
818759
Date Signed:
10/25/2012
Position With Company (Title):
meg: L1L-A0058091A-M0400001A-0000 Registration Date/Time: 2012/10/25 15:00:02 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms August 2009
INSTALLATION CERTIFICATE
{
Duct Leakage Test - Existing Duct System
(Page 1 of 2)
INSTALLATION CERTIFICATE
CF-6R-MECH-2I-HERS
Duct Leakage Test - Existing Duct System
(Page 1 of 2)
Site Address: -
❑ 3. Reduce leakage by,60% and conduct smoke and fix all leaks
52445 Avenida Navarro, La Quinta CA 92253 (System
Enforcement Agency:
Permit Number:
1)
City of La Quinta
12-00001246
Enter the Duct System Name or Identification/Tag: System 1
Enter the Duct System Location or Area Served: Whole House
Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the
dwelling.
This installation certificate is required for compliance for alterations and additions in existing dwellings to
space conditioning systems and duct systems.
Note: For existing dwellings, a completely new or replacement duct system can also include existing parts of
the original duct system (e.g., register boots, air handler, coil, plenums, etc.) if those parts are accessible
and they can be sealed. For a completely new or replacement duct system installed in an existing dwelling,
use the Installation Certificate titled 'Duct Leakage Test - Completely New or Replacement Duct System. "
Duct Leakage Diagnostic Test - existing duct system
Select one compliance method from the following four choices.
® 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 attempte(;. before utilizing{Option 4,),
Determine nominal Fan:. Flow using one of thelfolloWing three; calculation Methods.,
✓ ® Cooling:s'ystem method: Size of. condenser in Tons ifs i,400 = 1600 CFM
✓ ❑ Heating system method: 21'.J.x 'Output Capacity,inpThousands 'of Btu/hr = CFM
.s ;`
✓❑
Mea'sured,system`airflow using RA3 3`airflow-'test procedures:`
Option;1 used then:.. ,, a s �• ,. � �
-
Allowed leakage Fan Airflow '- 160V x0.15 -"� 240
�c
1
—CFM
Actual. Leakage- 221 CFM `
Pass if Actual Leakage is less than Allowed leakage
Pass Fail
Option'2 used then: 1 -jt
2
Allowed leakage = Fan Airflow•' x 0.10 = _ CFM
Actual Leakage to outside V- ."CFM
':*4 Pass if Actual leakage to outside is less than Allowed leakage
Pass 13Fail
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 reductionCFM
((Leakage reduction _ / Initial leakage x 100% _ /6 Reduction
Pass if % Reduction >= 600/c
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 C3 Fail
Keg: 112-Ao058091A-M2100001A-0000 Registration Date/Time: 2012/10/25 15:01:25 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms 1. March 2010
INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS
Duct Leakage Test - Existing Duct System (Page 2 of 2)
Site Address:
52445 Avenida Navarro, La Quinta CA 92253 (System Enforcement Agency: Permit Number:
1) City of La Quinta 12-00001246
® 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
supply return register ;boots must be, sealed to the drywall if smoke testis utilized for compliance
- applies to' duct leakage compliance option 3 '(leakage reduction by 60%) and option 4 {fix all accessible
leaks) described above..-,.-.
® New duct installations cannot utilize building cavities as,plenums'lor 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 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 -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. I will ensure that all Installation Certificates will come from a HERS provider data
registry for multiple orientation alternatives, and beginning October 1, 2010, for all low-rise residential buildings
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
PREC H & A INC
Responsible Person's Name:
Responsible Person's Signature:
Gerald Dobbins
Gerald bobbins
CSLB License:
818759
Date Signed:
10/25/2012
Position With Company (Title):
Is this installation monitored by a Third Party Quality
Name of TPQCP (if applicable):
Control Program (TPQCP)? ❑ Yes ❑ No
Reg: 212-A0058091A-M2100001A-0000 Registration Date/Time: 2012/10/25 15:01:25 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
INSTALLATION CERTIFICATE* CF-6R-MECH-25-HERS
Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 5)
Site Address: TEnfrorcement Agency: Permit Number:
52445 Avenida Navarro, La Quinta CA 92253 of La Quinta 12-00001246
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
foi 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
❑ No1
Ir
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.
YeSto l..and 2 is'a pass. I al' Enter Pass or Faill ✓ ® Pass ✓ ❑Fail
STMS =: Sensor on. -the Evaoorator'X'il
System ;Narne'o`r;Identification/Tag il,,,� ', , ; System l , - ' : _ i = 71
3
❑k es
l he sensor is facto dry installed or fieldxinstalled according to manufacturer s
p:No "specifications, or is, mstalle`d-by methods/specifications approved by the Executive `-
The sensor is factory installed, or field installed according to manufacturer's
6
r f Director.* 'G _M
4
❑Yes
� .� The sensor wiee is terminated with a standard mini plug suitable for connection'to a
p No digital`;thermorneterlThe
jx sensor mini -plug is accessible to the•installmg<techrneian
and ;the,HERS,rater;without.changing,the'airflow;thro ugh ugh coil
Laable.-Otherwis&ehter
[1Yes, , .
[3 No The sensor measures the saturation temperature of the coil within 1.3 degrees F
o 3 4 !and`5 is`a`�pass. Enter. N/A if STMS are not
✓ ® N/A
✓ ❑ Pass
✓ - ❑ Fail
Pass orTF':I
and the HERS rater without changing the airflow through the condenser coil
8
1 ❑ Yes
STMS - Sensor on the Condenser Coil
System Name or Identification/Tag- System 1
The sensor is factory installed, or field installed according to manufacturer's
6
❑ Yes
❑ No
specifications, or is installed by methods/specifications approved by the Executive
Director.
The sensor wire is terminated with a standard mini plug suitable for connection to a
7
[3 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
1 ❑ Yes
❑ No
lfhe 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
applicable. Otherwise enter Pass or Fail
,i ❑pass
✓ [3 Fail
t
Reg: 212-A0058091A-M2500001A-0000 Registration Date/Time: 2012/10/25 15:03:42 'HERS Provider:.CalCERTS, Inc.
2008 Residential Compliance Forms , Y 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:
52445 Avenida Navarro, La Qui nta CA 92253 City of La.Quinta 12-00001246
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 Conditionino Svstems
System Name or Identification/Tag
System 1
(must be re -calibrated monthly)
,. �
�`•
System Location or Area Served
Whole House
10/1/2012,,"t ; *
(must be re=calibrated monthly)
Outdoor Unit Serial #
7692w291212267
Outdoor Unit Make
Rheem
Outdoor Unit Model
13P]L48A01
Nominal Cooling Capacity Btu/hr
48000
[Date of Verification
10/25/2012
-
o M.1Wi 1 111111 YIIICIIL9
Date of Refrigerant Gauge Calibration '
10/1/2012
(must be re -calibrated monthly)
,. �
�`•
Supply (e\iaporato(,leaving),air dry-bulb il A
Date of moco
The�uple,Calibration
10/1/2012,,"t ; *
(must be re=calibrated monthly)
temperature (TSuPPIY,db)-
�g
System Name or Identiflcation/Tag�•. _
Imo` Lf ...._..�
System 1 ��'"
* •..
,. �
�`•
Supply (e\iaporato(,leaving),air dry-bulb il A
> *
t
temperature (TSuPPIY,db)-
Return (evaporator'entering) air dry-bulb
temperature " ' • .�
,(T return, db)
Return (evaporator entering) air wet -bulb
temperature (Treturn ' wb)-"- <'
75
Evaporator saturation temperature e
(T evaporator, sat) .-
38
Condensor saturation temperature
(Tcondensor, sat)
Suction line temperature (Tsuction)
48
Liquid Line Temperature (Tliquid)
Condenser. (entering) air dry-bulb
temperature (Tcondenser, db) `
75
91
Keg: 112-A0058091A-M2500001A-0000 Registration Date/Time: 2012/10/25 15:03:42-. HERS Provider:-CalCERTS, Inc.
2008 Residential Compliance Forms - August 2009
INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS
Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5)
Site Address: Enforcement Agency: Permit Number -
52445 Avenida Navarro, La Quinta CA 92253 City of La Quinta 12-00001246
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 i
Calculate: Actual Temperature Split = Treturn,
db - Tsupply, db
10.0
Target Temperature Split from Table RA3.2-3
using Treturn, wb and Treturn, db
10
Calculate difference: Actual Temperature Split -
Target Temperature Split =
0.00
Passes if difference is between -3°F and +3°F or,
upon remeasurement, if between -3°F and
PASS
-100°F
Enter Pass or Fail
_
Note: Temperature Split Method_ Calculation is not necessary if actual Cooling Coil Airflow is verified using one of the
airflow measurement procedures specified in Reference Residential Appendix RA3.3. If actual cooling 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 CFM Requirement q,. (CFM) =Nominal Cooling Capacity (ton) X 300 (dm/ton)
System N`akm'e}o_ r Ide tification/Tag a ry
"p .x?S§"-3•.• i'`u�.+a
y tem 1"
°�:.t+ as.m
n �
k! 3L,.-'S:R•�
Calculated Minimum Airflow. .RRettquiire{{mejnt (CFM)
y
1200-
"
`*
r ..
•L'.yy�� via+.' ,�
t._
Measured'Airflow us ng RA3 3procedures (CFM)
X1512
,�x
`�
Passes if measured airflow is greater than
equal to the calculated. minimum airflow,
requirementr'z� :'
PASS
Enter Pass or Fail
Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used
for fixed orifice metering device systems
System Name or Identification/Tag
System 1
Calculate: Actual Superheat =
Tsuction - Tevaporator, sat
10.0
Target Superheat from Table RA3.2-2 using
Treturn, wb and Tcondenser, db
10
Calculate difference:
Actual Superheat - Target Superheat =
0.00
System passes if difference is between -5°F and
+5°F
PASS
Enter Pass or Fail
Keg: z1a-Aoo58091A-M2500001A-0000 Registration Date/Time: 2012/10/25 15:03:42 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms �, + August 2009
INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS
Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5)
Site Address: Enforcement Agency: Permit Number:
52445 Avenida Navarro, La Quinta CA 92253 City of La Quinta 12-00001246
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
A!
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
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
A!
Calculate: Actual Superheat =
Tsuction - Tevaporator, sat
Enter allowable superheat range from
manufacturer's specifications (or use range
between 4°F and 25°F if manufacturer's
specification is not available)
System passes if:actual'superheat is=within=the'
allowable superheat range i
Enter'Pass or Fail
Reg: 212-A0058091A-M2500001A-0000 Registration Date/Time: 2012/10/25 15:03:42 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms August 2009
r
A!
Reg: 212-A0058091A-M2500001A-0000 Registration Date/Time: 2012/10/25 15:03:42 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms August 2009
INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS
Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5)
Site Address: Enforcement Agency: Permit Number:
52445 Avenida Navarro, La Quinta CA 92253 City of La Quinta 12-00001246
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:
818759
Date Signed:
10/25/2012
Position With Company Title
P y( ):
System meets all refrigerant charge and airflow
Name of TPQCP (if applicable):
Control Program (TPQCP)? ❑ Yes ❑ No
requirements.
PASS
Enter Pass or Fail
R.
yt e
y
17
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 -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 beciinnino October 1. 2010for all Inw-rice rrcir1pntial hiiilrli—
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
PREC H & A INC
Responsible Person's Name:
Responsible Person's Signature:
Gerald Dobbins
Gerald Dobbins
CSLB License:
818759
Date Signed:
10/25/2012
Position With Company Title
P y( ):
Is this installation monitored by a Third Party Quality
Name of TPQCP (if applicable):
Control Program (TPQCP)? ❑ Yes ❑ No
Keg: 211-AUU58U91A-M2500001A-0000 Registration Date/Time: 2012/10/25 15:03:42 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms August 2009