11-0069 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
c&t!t 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number:
11-00000069
Owner:
Property Address:
52475 AVENIDA CARRANZA
CITY OF LA QUINTA
APN:
773-285-013-1 -000000-
78495 CALLE TAMPICO
Application description:
MECHANICAL
LA QUINTA, CA 92253
Property Zoning:
COVE RESIDENTIAL
Application valuation:
5000
Applicant: Architect or Engineer:
------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and, effect.
License Class: - - -------- License No.: -C20
Date: L �- fntractor: V'
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).:
(_) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
and who does the work himself or herself through his or her own employees, provided that the
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
one year of completion, the owner -builder will have the burden of proving that he or she did not build or
improve for the purpose of sale.).
(_) 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 contractors) licensed
pursuant to the Contractors' State License Law.).
(_) 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 ISec. 3097, Civ. C.).
Lender's Name: AK
Lender's Address:
LQPERMIT
Contractor:
BUDGET AIR
PO BOX 1066
LA QUINTA, CA 92247
WCC: EXEMPT
Lic. No.: C20
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date:
JAN 2 0 2011
WORKER'S COMPENSATION DECLARATION
1/20/11
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 EXEMPT 05,3 119olicy Number 796186
�1 certify that, in the performance of the work for which this permit is issued, I shall not employ any.
person in any manner so as to become subject to the workers' compensation laws of California,
and agree that, if I should become subject to the workers' compensation provisions of Section
3700 of the Labor Code, I shall forthwith comply with those provisions.
ate: -i( scant:
WARNING: FAILURE TO SECURERKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
conditions and restrictions set forth on this application. .
1. Each person upon whose behalf this application is made, each person at whose request and for
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quinta, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work is not commenced
within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the above information is correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of thi >0-U.111y, to enter upon th ove-mentioned property for inspection purpo as.
D�( nature (Applicant or Agent):
Application Number . . . . . 11-00000069
Permit . . . MECHANICAL
Additional desc .
Permit Fee . . . .
40.50
Plan Check Fee
10.13
Issue Date . . . .
Valuation . . . .
0
Expiration Date
7/19/11
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
INSTALL 4 TON 14 SEER
A/C SPLIT SYSTEM.,
2010 CODES.
---------------------------------------------------------
Other Fees . . .
------------------
. . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged
Paid Credited
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
ATTENTION:KIRK
BUDGET -AM
HEATING AND AIR-CONDITIONING
(760)899-1606
Lie. 4796186
Proposal
Bill To: ON of La Quinta Date December 30, 2010
Address: P.O. Boz 1504 / 78495 Calle Tampico, La Quinta . CA 92247-1504
Job name and address: 52475 Avenida Carranza
La Quinta, CA 92253
Budget Air offers to install:
1. One 4 torr 14 seer Maytag air-conditioning split system.
Installation includes: installing a new 16" duct for return
air, run necessary gas line to new unit, necessary refrigerant
lines, pvc condensation line, &flue pipe, & new digital thermostat.
Also included in price is required HERS testing.
Total:
Buyer Seller
I.-5 -Lk 12/3012010
Date C a l e.d. Date
$ 5,000. --
L -d LLS L-LZZ-09L zenbzen N'8 f 86Z: 90 0 L 0£ 080
BID MEMO
JOB
BID #
ADDRESS
DATE
INCLUDED
FIRM
PREPARED BY ,
ADDRESS
APPROVED BY
TYPE OF
PHONE
WORK
WORK INCLUDED
AMOUNT OF BID
.. f Air,
AND QUALIFICATIONS
INCLUDED
RECEIVED BY:
i
tai s v
.Q
OOIMA
FA 1-L��
EXCLUSIONS
DELIVERY EXCLUDED
AND QUALIFICATIONS
INCLUDED
RECEIVED BY:
ACKNOWLEDGEMENT
OF ADDENDA: TAX
DELIVERY EXCLUDED
INCLUDED
RECEIVED BY:
Dano BID MEMO
ad— MADE IN USA
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -IR -ALT -HVAC
Climate Zones 10 to I5
Site Address: C 4,
E orcemetrt Agency:
Date.,-
Permit #�
r ni
/ /
g
Conditioned Floor
Equipment T er
List Minimum Efficienc z
Duct insulation requirement
Area
Thermostat
O Packaged Unit
&Furnace
0 AFUEZO/
❑ COP
Over 40 ft of ducts added or
�rSetback
RSafnot
i�. Indoor Coil
OSEER�
❑ HSPF
replaced in unconditioned space
Served by system
already
5LCondensing Unit
O EER 4a
0 Resistance
❑ R 6 (CZ 10-13)
13R 8 (CZ 14-15)
sf
present, must be
installed)
0 Other
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -1 R-ALT-f[VACfor each system.
2. Minimum Equipment Efficiencies: 13 SEER, 78%AFUE, 7.7HSPFfortypical 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
sir4ed. Beginning October 1, 2010 a registered copy of the CF -IR and CF -6R shall also be on site for final inspection.
1. HVAC Changeout
Required Forms:
• AI I. H VAC Equipment replaced
CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH- 25 -HERS
CF -411 forms: MECH- 21 and fors lits stems MECH-25
• Condenser Coil and /or
CF -6R forms: MECH-2I-HERS and (for split systems) MECH- 25 -HERS
• Indoor Coil and /or
CF -411 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 from duct leikage testing if:
0:1. Duct system was documented to have been previously sealed and confirmed through HERS verification, or
O 2. Duct systems with less than 40 linear feet in unconditioned space, or.
0 3. Existing duct systems are constructed, insulated or sealed with asbestos
0 2. New HVAC System Required Forms:
• Cut in or Changeout with new CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-22-HERS, and MECH-25-HERS
ducts: (all new ducting and all CF-41kforms: MECH 20-, and (for split systems)MECH-22,.and MECH 25
new a ui ment
For Split Systems: Duct leakage < 6 percent; RC, CCA >_ 350 CFM/ton, FWD, TMAH, STMS, and either HSPP or PSPP..
For Packaged Units: Duct leakage <6 percent
O 3. New Ducts with Replacement'
Required Forms:
• Includes replacing or installing all new ducting
CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-25-HERS
and/or outdoor condensing unit and/or indoor
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
O 4. New Ducting over 40 feet
Required Forms:
• Includes adding or replacing more than 40
CF -6R forms: MECH-04, MECH-2I-HERS CF -4R forms: MECH-21
linear feet of duct in unconditioned space..
For split system or packaged units: Duct leakage < 15 percent
0 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 cenify 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 6oftheCatifomiaCode ofRegulations.
• The design feawres identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance forms, worksheets,
calculationsplans and specifications submitted to the enforcement enc f approval with the permit application.
Name:�` A I Ake V ✓ i Signature: 4W
Company:
te:
Address:
License:
7q 61X -L
City/St atc/Zip: vtM
Phone: 7 0_ .
2008 Residential Compliance. Forms March 2010
Bin #
City of La Quinta
Building Sr Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
< <� to
Project Address:
Owner's Name: Q
A. P. Number:
Address: �7
[�- CO
Legal Description:
City, ST, Zip 0—),q 9225.3
Contractor:
T ele h ne:
7 70aO
��—
Address:
Project Description:
City, ST, Zip:
A4t_d" /
Telephone:
e
...............................................
State Lic. # : City Lic. C.
Arch., Engr., Designer:
Address:
City, ST, Zip:
ne:
Telephone-
State Lt c. #•
Construction 1YPe• Occupancy:
cY :
(circle one): New Add'n Alter Repairair Demo
o }ecttyP
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Q
Plans resubmitted
Mechanical
Grading plan
2°" Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'"' Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC CF-1R-ALT-HVAC
Alterations
Climate Zones 10 - 15
,Site Address:
Enforcement Agency:
Date:
Permit #-
52475 AVE CARANZA La Quinta, CA 92253
City of La Quinta
Apr 6, 2011
Duct insulation
Conditioned Floor
Equipment Type1
List Minimum Efficiency2
requirement
Area
Thermostat
❑ PackageUnit
0 Furnace
0 AFUE 78%
ED COP
❑ R 6 (CZ 10-13)
Served by system
0 Setback
0 Indoor Coil
0 SEER 14.0
L] HSPF
E]R 8 (CZ 14-15)
3.500
If not already present,
0 Condensing Unit
❑ EER
F) Resistance
must be 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-4R forms (no hand filled CF-4Rs allowed) are filled out and signed.Beginning
October 1, 2010, a registered copy of the CF-IR and CF-6R shall also be on site for final inspection.
D 1. HVAC Changeout
Required Forms:
. All HVAC Equipment
CF-611 forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
replaced
CF-411 forms: MECH-21 and (for split systems) MECH-25
. Condenser Coil and /or
. Indoor Coil and /or
CF-6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
. Furnace
CF-411 forms: MECH-21 and (for split systems) MECH-25
For Split Systems: Duct leakage < 15 percent; RC, CCA <_ 300 CFM/ton (Minimum Air Flow Requirement), TMAH
For Packaged Units: Duct leakage < 15 percent
Exempted from duct leagage testing if:
❑ 1. Duct system was documented to have been previously sealed and confirmed through HERS verification, or
❑ 2. Duct systems with less than 40 linear feet in unconditioned space, or
❑ 3. Existing Idu,ct.systems are constructed," insulated or, sealed with asbestos
System( 2. NeW HVAC
Requiredtms: fr y
1 �I►! L�
. Cut in or Changeout
with new ducts: all
s(
CF-6R forms: MECH-04 MECH-20-HERS and (for split systems) MECH-2i=HERS ands,`+ ,,n
MECH=25IHER5 /i► - 7 /
new ducting and all
'�
it
CF-4R forms': MECH 20, and (for_split systems) MECH-22, and MECH 25� .1%
new equipment) ,
For Split Systems: Duct leakage < 6 percent; RC, CCA >_ 350 CFM/ton, FWD, TMAH, STMS, and either HSPP or PSPP.
For Packaged Units: Duct leakage < 6 percent
❑ 3. New Ducts with/or without
Required Forms:
Replacement
. Includes replacing or installing all
new ducting and/or outdoor
CF-611 forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS
condensing unit and/or indoor coil
CF-411 forms: MECH-20 and (for split systems) MECH-25
and/or furnace. No or some
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
CF-611 forms: MECH-04, MECH-2I-HERS
than 40 linear feet of duct in
CF-411 forms: MECH-21
unconditioned space.
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: ]AIME VASQUEZ Signature: JAIME VASQUEZ
Company: BUDGET - AIR Date: Apr 6, 2011
Address: P 0 BOX 1066 License: 796186
City/State/Zip: LA QUINTA / CA / 92253 Phone: (760) 784-5333
a Q
Reg: 211-A0017140A-00000000-0000 Registration Date/Time: 2011/04/06 00:20:42 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms July 2010
INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS
Duct Leakage Test — Existing Duct System (Page 1 of 2)
Site Address:
52475 AVE CARANZA, La Quinta CA 92253 (System
Enforcement Agency:
Permit Number:
1�
City of La Quinta
11-0069
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.
compliance for alterations and additions in existing dwellings to
duct
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.
R 1. Measured leakage less than 15% of fan flow
❑ 2. Measured leakage to outside less than 10% of Fan Flow
❑ 3. Reduce leakage by 60% and conduct smoke and fix all leaks
❑ 4. Fix all accessible leaks using smoke and HERS rater verify
Note: (One of Options 1, 2 or 3 must be attempted, before_.utili_z_ing Option 4.)_
Determine nominal Fan Flow using one of the following three calculation methods. '
✓ Cooling system methodSize condenser in Tons x400 = 1600 CFM
it
u
jof
k.
✓ ❑ 21.7 � Output Capaly in; housands hr CFM
Heating system method:of t = _
g procedures:
_
✓ ❑ Measured, sysEem atirf ow' us RA3.3 airflow test CFM _ „�*
f �3,
Option i used then:
1
Allowed leakage = Fan Airflow 1600 x 0.15 = 240 CFM
Actual Leakage 84 CFM
Pass if Actual Leakage is less than Allowed leakage
0 Pass ❑ Fail
Option 2 used then:
2
Allowed leakage = Fan Airflow _ x 0.10 = _ CFM
Actual Leakage to outside = CFM
Pass if Actual leakage to outside is less than Allowed leakage
❑ 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% _ 0/a Reduction
Pass if % Reduction > 600/a
❑ 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
R
Reg: 211-A0017140A-M2100001A-0000 Registration Date/Time: 2011/04/06 00:26:06 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS
Duct,.Leakage Test — Existing Duct System (Page 2 of 2)
Site Address:
52475 AVE CARANZA, La Quinta CA 92253 (System
Enforcement Agency:
Permit Number:
1)
City of La Quinta
11-0069
0 Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off
during duct leakage testing. CFI OA ducts that utilize controlled motorized dampers, that open only when OA
ventilation is required to meet ASHRAE Standard 62.2, and close when OA ventilation is not required, may
be configured to the closed position during duct leakage testing.
9 All supply and return reg ister'boots�must be sealed+to the drywall if.s'moke test Is utili ed for, compliance
— appliestto duct leakage compliance option 3 (leakage reduction ;by and option 4�(fix ccessible
leaks) described above 1 \11�,
0
0 New duct installationafcannot utilize building cavities astplenums�o r platform returns in lieu of ducts ' Q
�. r �1[ +C:�C ,
• Mastic and draw bands must be used in combination with cloth backed rubber adhesive duct tape to seal
leaks at all new duct connections
DECLARATION STATEMENT
• I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct.
• I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized
representative of the person responsible for construction (responsible person).
. I certify that the installed features, materials, components, or manufactured devices identified on this certificate (the installation)
conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the
enforcement agency.
• I understand that a HERS rater will check the installation to verify compliance, and that that if such checking identifies defects, I am
required to take corrective action at my expense. I understand that Energy Commission and HERS provider representatives will also
perform quality assurance checking of installations, including those approved as part of a sample group but not checked by a HERS
rater, and if those installations fail to meet the requirements of such quality assurance checking, the required corrective action and
additional checking/testing of other installations in that HERS sample group will be performed at my expense.
• I reviewed a copy of the Certificate of Compliance (CF -SR) form approved by the enforcement agency that identifies the specific
requirements for the installation. I certify that the requirements detailed on the CF -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)
BUDGET - AIR
Responsible Person's Name:
Responsible Person's Signature:
JAIME VASQUEZ
JAIME VASQUEZ
CSLB License:
Date Signed:
Position With Company (Title):
796186
3/7/2011
Is this installation monitored by a Third Party Quality
Name of TPQCP (if applicable):
Control Program (TPQCP)? E] Yes []No
Reg: 211-A0017140A-M2100001A-0000
2008 Residential Compliance Forms
Registration Date/Time: 2011/04/06 00:26:06 HERS Provider: CalCERTS, Inc.
March 2010
INSTALLATION CERTIFICATE* CF-6R-MECH-25-HERS
Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 5)
Site Address: Enforcement Agency:711-0069
Permit Number:
52475 AVE CARANZA, La Quinta CA 92253 City of La Quinta
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
p 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
p 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 ✓ 0 Pass ✓ ❑ Fail
STMS - Sensor on,the Evaporator Coil
System Name or Identification/Tag'f
/ /,� System 1 1 1 , 1 N P1 it / (I
if
3
r
(E] Yes
EI -14
The sensor is factory installed,oryfield installed according to manufacturer's
specifications, or islinstalled by methods/specifications approved by the Executive
❑ Yes
❑ No
if r 1 I
Director.
4
E] Yes
p Not�
The sensor wife is terminated with a standard mini plug suitable for connection to a!
digital thermometer.'The sensor, mini plug is accessible to the installing teclinicia"n Q7]
The sensor wire is terminated with a standard mini plug suitable for connection to a
and the HERS rater without changing the airflow through the condenser coil
5
❑ Yes
I ❑ No
IThe sensor measures the saturation temperature of the coil within 1.3 degrees F
Yes to 3, 4, and 5 is a pass. Enter N/A if STMS are not
✓ N/A
✓ El Pass
✓ ❑Fail
applicable. Otherwise enter Pass or Fail
❑ No
The sensor measures the saturation temperature of the coil within 1.3 degrees F
Yes to 6, 7, and 8 is a pass. Enter N/A if STMS are not
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
❑ Yes
❑ No
digital thermometer. The sensor mini plug is accessible to the installing technician
and the HERS rater without changing the airflow through the condenser coil
8
❑ Yes
❑ No
The sensor measures the saturation temperature of the coil within 1.3 degrees F
Yes to 6, 7, and 8 is a pass. Enter N/A if STMS are not
✓ D N/A
✓ ❑Pass
✓ ❑Fail
applicable. Otherwise enter Pass or Fail
-M
i
Reg: 211-A0017140A-M2500001A-0000 Registration Date/Time: 2011/04/06 00:34:43 HERS Provider: CalCERTS, 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:
52475 AVE CARANZA, La Quinta CA 92253 1 City of La Quint a 11-0069
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)
�s
Date of Therm coupie,Calibration �
77
t
2%15/2011) G . �P
System Location or Area Served
Whole House
!
/ t
Outdoor Unit Serial #
MSDIO1103418
Outdoor Unit Make
MAYTAG
Outdoor Unit Model
MSA4BE048K
Nominal Cooling Capacity Btu/hr
48000
Date of Verification
3/7/2011
Calibration of Diagnostic Instruments
Date of Refrigerant Gauge Calibration
2/15/2011
(must be re -calibrated monthly)
�s
Date of Therm coupie,Calibration �
77
t
2%15/2011) G . �P
(must be re calibrated monthly)
/ I
!
/ t
Measured Temberatures'(.?F) l I 1 1` 5e—f 1 1 l \. A
I 'ff 1 It
System Name or Identification/Tag
r '
System 1
�
Supply (evaporator leaving) air dry-bulb '
T 51�-
temperature (Tsupply, db)
Return (evaporator entering) air dry-bulb
71
temperature (Treturn db)
Return (evaporator entering) air wet -bulb
58
temperature (Treturn, wb)
Evaporator saturation temperature
32
(Tevaporator, sat)
Condensor saturation temperature
86
(Tcondensor, sat)
Suction line temperature (Tsuction)
50
Liquid Line Temperature (Tliquid)
77
Condenser (entering) air dry-bulb
temperature (Tcondenser, db)
I
Reg: 211-A0017140A-M2500001A-0000 Registration Date/Time: 2011/04/06 00:34:43 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms August 2009
INSTALLATION CERTIFICATE CF-611-MECH-25-HERS
Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5)
Site Address: Enforcement Agency: Permit Number:
52475 AVE CARANZA, La Quinta CA 92253 1 City of La Quinta 11-0069
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,
20
db - Tsupply, db
Target Temperature Split from Table RA3.2-3
19.3
using Treturn, wb and Treturn, db
Calculate difference: Actual Temperature Split -
0.7
Target Temperature Split =
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 Requirement (CFM) = Nominal Cooling Capacity (ton) X 300 (cfm/ton)
System e o Identification/Tag
S ystem 1
f�j
,Ifl
1
Calculated Minimum Airfloww Requirement (CFM)
7r
a
Measured Airflow;us ngRA3.3 p ocedu es (('-FM)
- r�
')16C.
Passes if measured airflow is greater than or
equal to the calculated minimum airflow
requirement.
Enter Pass or Fail
Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used
for fixed orifice metering device systems
System Name or Identification/Tag
System 1
Calculate: Actual Superheat =
Tsuction - Tevaporator, sat
Target Superheat from Table RA3.2-2 using
Treturn, wb and Tcondenser, db
Calculate difference:
Actual Superheat - Target Superheat =
System passes if difference is between -5°F and
+5°F
Enter Pass or Fai
791
n
Reg: 211-A0017140A-M2500001A-0000 Registration Date/Time: 2011/04/06 00:34:43 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms August 2009
INSTALLATION CERTIFICATE CF-6R-MECH-25-HERSI
Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5)
Site Address: Enforcement Agency: Permit Number:
52475 AVE CARANZA, La Quinta CA 92253 1 City of La Quint a 11-0069
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 =
9
Tcondenser, sat - Tliquid
Target Subcooling specified by manufacturer
10
Calculate difference:
-1
Actual Subcooling - Target Subcooling =
System passes if difference is between
-3°F and +3°F
PASS
Enter Pass or Fail
Jt
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 =
18
Tsuction - Tevaporator, sat
Enter allowable superheat range from
manufacturer's specifications (or use range
4„25
between 4°F and 25°F if manufacturer's
specification is not available)
System passes -if actual superheat is within,the
allowable superheat range
PASS
f Enter Pass or Fail
Jt
Reg: 211-A0017140A-M2500001A-0000 Registration Date/Time: 2011/04/06 00:34:43 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:
52475 AVE CARANZA, La Quinta CA 92253 1 City of La Quinta 11-0069
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:
Date Signed:
Position With Company (Title):
System meets all refrigerant charge and airflow
3/7/2011
Is this installation monitored by a Third Party Quality
Name of TPQCP (if applicable):
requirements.
PASS
Enter Pass or Fail
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 -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 beginning October 1, 2010, for all low-rise residential buildings.
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
BUDGET - AIR
Responsible Person's Name:
Responsible Person's Signature:
JAIME VASQUEZ
JAIME VASQUEZ
CSLB License:
Date Signed:
Position With Company (Title):
796186
3/7/2011
Is this installation monitored by a Third Party Quality
Name of TPQCP (if applicable):
Control Program (TPQCP)? ❑ Yes ❑ No
Reg: 211-A0017140A-M2500001A-0000 Registration Date/Time: 2011/04/06 00:34:43 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms August 2009