12-0827 (MECH)— (..
P.O. BOX 1504
78-495 CALLB TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: _ `12�0� 0. 082
Property Address: C79S55—CETRINO
APN: 772 -330 -042 -
Application description: MECHANICAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 6867
Applicant:
Tu�144Q"
Architect or Engineer:
d1 A
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
GORDON AUCK
79555 CETRINO
LA QUINTA, CA 92253
Contractor:
AIR PRO SERVICES
P.O. BOX 1120
CATHEDRAL CITY,
(760)343-5502
Lic. No.: 780198
VOICE (760) 777-7012
PAY (760) 777-7011
3
CA 92235
----------------------------------------------------------------'---------------------------------
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 Professional fie, 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
License Class: C20 i sits_ No.: 780198
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
%—ZS -/J- ��
ate: _ ntractor:
issued.
� I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
11
/
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 t I am exempt from the Contractor's State License Law for the
Carrier NORGUARD INS Policy Number AIWC346635
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to
_ I 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 become sublet a workers' compensation provisions of Section
License Law (Chapter 9 (commencing with -Section 7000) of Division 3 of the Business and Professions Code) or
3700 of t Labor Code, I sha forth h co ply with those provisions.
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 155001.:
te: pplicant:
( _ 1 1, 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: FAILURE TO SECURE WO ERS' 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 CRIMI AL 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.).
(_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
l _ 1 I am exempt under Sec. , B.&P.C. for this reason
Date: Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPERMIT
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, a d reby authorize representatives
of t/hiiVounty to enter upo he above-mentioned property for ins coon pos
�e: 7� ignature (Applicant or Agent):
a
Application Number . . . . . 12-00000827
Permit MECHANICAL
Additional desc . .
Permit Fee . . . . 40.50 Plan Check Fee
10.13
Issue Date . . . . Valuation . . . .
0
Expiration Date .1/21/13
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 0UT: INSTALLLNEW FURNACE,
COIL, CONDENSING UNIT. 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
P1an.Check Total 1.0.13 .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:
Enforcement Agency:
Date:
7
Permit #:
79555 CETRINO La Quinta, CA 92253
City of La Quinta
Jul 25, 2012
Duct insulation
Conditioned Floor
Equipment Typel
List Minimum Efficiency2
requirement
Area
Thermostat
❑ Package Unit
p Furnace
0 AFUE 78%
❑ COP
❑ R 6 (CZ 10-13)
Served by system
2 Setback
p Indoor Coil
p SEER 13.0
❑ HSPF
❑ R 8 (CZ 14-15)
1313 sf
If not already present must be
m Condensing Unit
[I EER
❑ Resistance
installed)
❑ Other
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF-IR-ALT-HVAC for each system.
2. Minimum Equipment Efficiencies: 13 SEER, 78% AFUE, 7.7HSPF for typical residential systems.
HERS VERIFICATION SUMMARY Listed below are FOUR HVAC alteration Options. The installer decides what work is being done
and picks one of the appropriate Options. Each Option lists the HERS measures that must be conducted. A copy of the forms shall
be left on site for final inspection and a copy given to the homeowner. At final, the inspector verifies that the work listed on this
form was in fact the work completed by the installer. The inspector also verifies that each appropriate CF-6R and registered CF-4R
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.
D 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
. Indoor Coil and /or
CF-6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
. Furnace
CF-4R 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
FGF Parskaged Unit—s- Duet leakage 4 15
peFEefit
Exempted from duct leakage testing if:
❑ 1. Duct system was documented to have been previously sealed and confirmed through HERS verification, or
❑ 2. Duct systems with less than 40 linear feet in unconditioned space, or
❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos
❑ 4. The system will not be Ducted (ie. Ductless Mini-Split System) (Also Exempt from Refrigerant Charge)
❑ 2. New HVAC System
Required Forms:
. Cut in or Changeout with
new ducts: (all new
CF-6R forms: MECH-04, MECH-20-'HERSi and (for split systems) MECH-22-HERS, and
ducting and all new
MECH-25-HERS
CF-4R forms: MECH-20, and (for split systems) MECH-22, and MECH-25
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 condensing unit
CF-6R forms: MECH-04; MECH-20-HERS, and (for split systems) MECH-25-HERS
and/or indoor coil and/or furnace. No or some
CF-4R forms: MECH-20 and (for split systems) MECH-25
equipment changed.
For Split Systems: Duct leakage < 6 percent; RC, CCA >_ 300 CFM/ton, TMAH
For Packaged Units: Duct leakage < 6 percent
❑ 4. New Ducting over 40 feet
Required Forms:
. 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: Joe Priest Signature: Joe Priest
Company: AIR PRO SERVICES CORPORATION Date: Jul 25, 2012
Address: P O BOX 1120 License: 780198
City/State/Zip: CATHEDRAL CITY / CA / 92235 Phone: (760) 343-5502
Reg: 212-A0039819A-00000000-0000 Registration Date/Time: 2012/07/25 15:23:28 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms July 2010
Bin #
City of La Quinta
Building & Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #1 n
IZ' j
Project Address: 7 S 5 CJ Ce
Owner's Name: o A UC
A. P. Number:
Address: 79 S S @ , ivb
Legal Description:
Contractor:
v eec
�
City, ST, Zip: L4 Quti4�4
Telephone: hone:
Dk
Address: 7a0U og • SAA- Sbeee -/ Sup• t
Pro jectDescription:
City, ST, Zip: �r/U S GiQ M76
A
G�Aru eelIZ7 P1/4 C e��•
Telephone: le h e.
0 Gi-
P - 5 S v1
7 3 y3
:City
•L f -
Lo N
State Lic. # : % p
Lic.+#•.
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
.......................................................
Construction n TYPe: Occupancy:
anc Y
State ic. #:
Pro'ecttY P (circle one): New Add'n Alter Repair Demo
Name of Contact Person: ,j e e ?A. GS
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: 7 &0- 3 43 .5 e 1
Estimated Value of Project:ev 7,
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cates.
Called Contact Person
Platt Check Balance
Title 24 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2n'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
J;
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 5)
Site Address: Enforcement Agency712-827 Permit Number:
79555 CETRINO, 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
BEDROOMS
1
® Yes
❑ No5/16
inch (8 mm) access hole upstream of evaporative coil in the return plenum and
labeled according to Figure in Section RA3.2.2.2.2.
2
® Yes
[]No
5/16 inch (8 mm) access hole downstream of evaporative coil In the supply plenum
and labeled according to Figure in Section RA3.2.2.2.2.
Yes to 1 and 2 is a pass.
Enter Pass or Faill ✓ ® Pass ✓ ❑Fail
STMS - Sensor.on,the Evaporator Coil - ..
System Name or Identification/Tag'l
/ / System i - ,( : !, #-I f " y r F I i
No
The sensor is factory installed; or;field installed according to manufacturer's .
3
❑Yes
❑
specifications, or is'installed by methods/specificatlons approved by the Executive
f
Director.
The sensor wire is terminated with a standard mini plug suitable for connection to a
The sensor wire is terminated with a standard mini plug suitable for connection,b a,
4
❑ Yes
_. ❑ No
digital thermometer. The sensor mini plug is accessible to Ehe:insiallinb tectinidan�,
and the HERS rater without changing the airflow through the condenser coil
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.
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
0
Reg: 212-A0039819A-M2500001A-M25A Registration Date/Time: 2013/01/10 19:33:91 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
v •z
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5)
Site Address: Enforcement Agency: Permit Number:
79555 CETRINO, La Quinta CA 92253 1 City of La Quinta 12-827
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 i
(must be re -calibrated monthly)
! r art
System Location or Area Served
BEDROOMS
12/4/12 4
:(must be r calibrated monthly)
Outdoor Unit Serial #
8394W291201899
Outdoor Unit Make
RHEEM
Outdoor Unit Model
13AJN48A01
Nominal Cooling Capacity Btu/hr
48000
Date of Verification
12/13/12
Calibration of Diagnostic Instruments
Date of Refrigerant Gauge Calibration
12/4/12
(must be re -calibrated monthly)
! r art
Date of Thermocouple,Calibration r f ,'
12/4/12 4
:(must be r calibrated monthly)
Supply (evaporator leaving) air dry-bulb
47
Measurea Temperatures (fir) ) I —Zf ( .. S It i'
System Name or Identification/Tagf
System 1
! r art
Supply (evaporator leaving) air dry-bulb
47
temperature (Tsupply, db)
Return (evaporator entering) air dry-bulb
70
temperature (Treturn, db)
Return (evaporator entering) air wet -bulb
55
temperature (Treturn, wb)
Evaporator saturation temperature
30
(Tevaporator, sat)
Condensor saturation temperature
72
(Tcondensor, sat)
Suction line temperature (Tsuction)
53
Liquid Line Temperature (Tliquid)
68
Condenser (entering) air dry-bulb
62
temperature (Tcondenser, db)
1
ti
Reg: 212-A0039819A-M2500001A-M25A Registration Date/Time: 2013/01/10 19:33:41 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
iiNSTALLATION CERTIFICATE CF-4R-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5)
Site Address: Enforcement Agency: Permit Number:
79555 CETRINO, La Quinta CA 92253 """""""`7City of La Quinta 12-827
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,
23.00
db - Tsupply, db
Target Temperature Split from Table RA3.2-3
20
using Treturn, wb and Treturn, db
Calculate difference: Actual Temperature Split -
3
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 Name or Idenbfication/Tag�j
Calculated Minimum Airflow Requirement (CFM)
�4
t Jf 1 f l i
Measured-Airflow-u"i g RA3.3 procedures.(CFM)r
• J�,Fr
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
Calculate: Actual Superheat =
Tsuction - Tevaporator, sat
Target Superheat from Table RA3.2-2 using
Treturn, wb and Tcondenser, db
Calculate difference:
Actual Superheat - Target Superheat =
System passes if difference is between -6°F and
+6°F
Enter Pass or Fail
A
Reg: 212-A0039819A-M2500001A-M25A Registration Date/Time: 2013/01/10 19:33:41 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
INSTALLATION CERTIFICATE CF-411-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5)
Site Address: Enforcement Agency: Permit Number:
79555 CETRINO, La Quinta CA 92253 1 City of La Quinta 12-827
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 =
4.0
Tcondenser, sat - Tliquid
Target Subcooling specified by manufacturer
5
Calculate difference:
-1
Actual Subcooling - Target Subcooling =
System passes if difference is between
�,
-4°F and +4°F
PASS
,` _. ♦'
r -_r f
Enter Pass or Fail
PASS
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 =
23.0
Tsuction - Tevaporator, sat
Enter allowable superheat range from
manufacturer's specifications (or use range
23
between 3°F and 26°F if manufacturer's
specification is not available)
�,
System passesif actual superheat is'within'the
" 9 \- r
f�`,
,` _. ♦'
r -_r f
allowable superheat range f / ,'
PASS
1 Enter Pass or Fail
I -.,#
r_
Reg: 212-A0039819A-M2500001A-M25A Registration Date/Time: 2013/01/10 19:33:41 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:
79555 CETRINO, La Quinta CA 92253 1 City of La Quint a 12-827
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
780198
HERS Provider Data Registry Information
Sample Group # (if applicable): N/A
System meets all refrigerant charge and airflow
not-tested/verified dwelling in❑ERS
sample group
requirements.
PASS
Air Experts Air Conditioning
Responsible Rater's Name:
Responsible Rater's Signature:
Enter Pass or Fail
Paul Van Vlymen
Responsible Rater's Certification Number w/ this HERS Provider:
Date Signed: 12/13/2012
CC2004367
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 -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)
AIR PRO SERVICES CORPORATION
Responsible Person's Name:
CSLB License:
Joe Priest
780198
HERS Provider Data Registry Information
Sample Group # (if applicable): N/A
tested/verified dwelling
not-tested/verified dwelling in❑ERS
sample group
HERS Rater Information CalCERTS Certificate # CC1-1798676408
HERS Rater Company Name:
Air Experts Air Conditioning
Responsible Rater's Name:
Responsible Rater's Signature:
Paul Van Vlymen
Paul Van Vlymen
Responsible Rater's Certification Number w/ this HERS Provider:
Date Signed: 12/13/2012
CC2004367
Reg: 212-A0039819A-M2500001A-M25A Registration Date/Time: 2013/01/10 19:33:41 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-21
Duct Leakage Test — Existing Duct System (Page 1 of 2)
Site Address: Enforcement Agency: Permit Number:
79555 CETRINO, La Quinta CA 92253 (System 1) City of La Quinta 12-827
Enter the Duct System Name or Identification/Tag: System i
Enter the Duct System Location or Area Served: BEDROOMS
Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the
dwelling.
This installation certificate is required for compliance for alterations and additions in existing dwellings to
space conditioning systems and duct systems.
Note: For existing dwellings, a completely new or replacement duct system can also include existing parts of
the original duct system (e.g., register boots, air handler, coil, plenums, etc.) if those parts are accessible
and they can be sealed. For a completely new or replacement duct system installed in an existing dwelling,
use the Installation Certificate titled "Duct Leakage Test - Completely New or Replacement Duct System. "
Duct Leakage Diagnostic Test - existing duct system
Select one compliance method from the following four choices.
❑ 1. Measured leakage less than 15% of fan flow
❑ 2. Measured leakage to outside less than 10% of Fan Flow
❑ 3. Reduce leakage by 60% and conduct smoke and fix all leaks
® 4. Fix all accessible leaks using smoke and HERS rater verify
Note: (One of Options 1, 2, or 3 must be attempted before utilizing Option 4.)
Determine nominal! Fan, Flow using one of the, fol lowing,three: calculation.methods.
® Coolingsystem method: Size o"f condenser in Tons 14 ` x 400 = 1600 CFM
^ f/ i , ! , ,%.. - 1.
✓ ❑ Heating system me/ththo-^1
21.7 x _ Output Capacity in Thousands of Btu/hr = — CFM
❑ Measured system airflow using/ airflow,test$rocedure,s: CFM
Option 1 used then: r ` --s ' : _ _ " , y •-. F C
�L(
{.
1
Allowed leakage = Fan Flow 1600 x 0.15 = 240 CFM
Actual Leakage = 454 CFM
Pass if Leakage Actual is less than Allowed
Pass Cl Fail
Option 2 used then:
2
Allowed leakage = Fan Flow :1600 x 0.10 = 160 CFM
Actual Leakage to outside = , CFM
Pass if Leakage Actual is less than Allowed
Pass p Fail
Option 3 used then:
Initial leakage prior to start of work = _ CFM
Final leakage after sealing all accessible leaks using smoke test = CFM
3
Initial leakage _ - Final leakage _ = Leakage reduction _ CFM
((Leakage reduction _ / Initial leakage _) x 100% _ % Reduction
Pass if % Reduction >= 60%
Pass 0 Fail
Option 4 used then:.
4
All accessible leaks repaired using smoke test. HERS rater must verify (No sampling).
Pass if all accessible leaks have been repaired using smoke
pq
Pass Fail
Reg: 212-A0039819A-M2100001A-M21A Registration Date/Time: 2013/01/10 19:30:45 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-21
Duct Leakage Test - Existing Duct System (Page 2 of 2)
Site Address: Enforcement Agency: Permit Number:
79555 CETRINO, La Quinta CA 92253 (System 1) City of La Quinta 12-827
® Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off
during duct leakage testing. CFI OA ducts that utilize controlled motorized dampers, that open only when OA
ventilation is required to meet ASHRAE Standard 62.2, and close when OA ventilation is not required, may
be configured to the closed position during duct leakage testing.
® All supplyand-returnregister boots must, be, sea led=to the d - all:if smoke,test,isrutilized'for.compliance
- applies to.duct leakage compliance option 3 (leak' ge-�eductio,n by 60%}�androptioni4iz ali accessible
leaks described above. `
® New duct installations cannot utilize building cavities as plenums or platfor/ returns -in lieu'of ducts.
® Mastic and -draw bands.must'be used s in combination:with'cloth.backed,rubberadhesive,duct�tape,to seal.; 'Q
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 -6R)
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
AIR PRO SERVICES CORPORATION
Responsible Person's Name:
CSLB License:
Joe Priest
1780198
HERS Provider Data Registry Information
Sample Group # if applicable): N A
P p' ( pP ) /
® tested/verified dwelling
tedjverified dwelling in
FaHETRSsample
group
HERS Rater Information CalCERTS Certificate # CCI -1798676408
HERS Rater Company Name:
Air Experts Air Conditioning
Responsible Rater's Name:
Responsible Rater's Signature:
Paul Van Vlymen
Paul Van Vlymen
Responsible Rater's Certification Number w/ this HERS Provider:
Date Signed: 12/13/2012
CC2004367
Reg: 212-A0039819A-M2100001A-M21A Registration Date/Time: 2013/01/10 19:30:45 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010