10-0221 (MECH)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T-ityl 4 XP Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/18/10
Application Number:
10-00000221
Owner:
Property Address:
53710 AVENIDA RUBIO
LA QUINTA REDEVELOPMENT
AGENCY
APN:
774-113-010-15 -000000-
78495 CALLE TAMPICO
Application description:
MECHANICAL
LA QUINTA, CA 92253
Property Zoning:
COVE RESIDENTIAL
Application valuation:
4000
Contractor: 0
Applicant:
Architect or Engineer:
SPEEDY AIR CONDITION
54685 AVENIDA HERRE
LA QUINTA, CA 92253
4�IF�
J 2610
(760)567-0133
LiC. Noo..:: 834471
C►T'Y OF
fLAQUINTA
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: C20 Li ense : 834471
)l4atey0 Contractor: ,
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
(_ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The.
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
and who does the work himself or herself through his or her own employees, provided that the
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
one year of completion, the owner -builder will have the burden of proving that he or she did not build or
improve for the purpose of sale.).
(_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
(_ 1 I am exempt under Sec. , B.&P.C. for this reason
* Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPERAIIT
WORKER'S COMPENSATION DECLARATION
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 EX •MPT Policy Number EXEMPT
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 all forthwith co ply those provisions.
)6ateZ" Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made,to the Director of Building and Safety for a permit subject to the
conditions and restrictions set forth on this application.
1. Each person upon whose behalf this application is made, each person at whose request and for
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quinta, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work is not commenced
within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the above information is correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this county to enter upon the above-mentionedproperty f inspection pur es.
a
fgat Signature (Applicant or Agent): �-
..- r
Application Number . . . . . 10-00000221
Permit . . . MECHANICAL
Additional desc .
Permit Fee 38.00
Plan Check Fee
7.88
Issue Date . . . .
Valuation
0
Expiration Date 9/14/10
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 16.5000 EA MECH B/C
>3-15HP/>100K-500KBTU
16.50
1.00 6.5000 EA MECH AH
<=10K CFM
6.50
----------------------------------------------------------------------------
Special Notes and Comments
_-- _-- ._----------.-___--- .____ ._-- - HVAC .CHANGE OUT: 4T HEAT ' PUMP 'SPLIT
_
SYSTEM [13 SEER MINIMUM] - 2007/2008
CALIFORNIA CODES
March 18, 2010 2:36:06 PM AORTEGA
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG
STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid
-------------------------------------
Credited
--------------------
Due
Permit Fee Total 38.00
.00 .00
38.00
Plan Check Total 7.88'
.00 .00
7.88
Other Fee Total 1.00
.00 .00
1.00
Grand Total 46.88
.00 .00
46.88
LQPERMIT
Simplified Prescriptive Certificate of Compliance: 2008 Residential HVACAIterations CF -IR -ALT -HVAC
Climate Zones 10 to 15
Site Address:
Enforcement Agency:
Floor
Permit #:
Equipment T e' List Minimum Efficiency' Duct insulation re uirementQ Area Thermostat
❑ Packaged Unit Over 40 ft of ducts added or
❑ F mace ❑ AFUE ❑ COP n Setba,k
P11
replaced in unconditioned space Served by system (If not already
C1"[9door Coil ❑SEER f: ❑ HSPF 7. ❑ R 6 (CZ 10-13) sf present, must be
Condensing Unit ❑ EER ❑ Resistance ❑ R 8 (CZ 14-15) installed)
❑ Other
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -1 R -ALT -HVAC for each system.
2. Minimum Equipment Efficiencies: 13 SEER, 78% AFUE, 7.7HSPF for typical residential systems.
HERS VERIFICATION SUMMARY Listed below are four HVAC alterationOptions. The installer decides what work is being done and
picks one of the appropriate Options. Each Option lists the HERS measures that must be conducted. A copy of the forms shall be left on site for final
inspection and a copy given to the homeowner. At final, the inspector verifies that the work listed on this form was in fact the work completed by the
installer. The inspector also verifies that each appropriate CF -6R and registered CF -4R forms (no hand filled CF-4Rs allowed) are filled out and
signed. Beginning October 1, 2010, a registered copy of the CF -1R and CF -611 shall also be on site for final inspection.
1. HVAC Changeout Required Forms:
• All HVAC Equipment replaced CF -6R forms: MECH-04, MECH-2I-HERS and (for split syste s) lMCMit 1 �5SLA QUI NTA
CF -4R forms: MECH- 21 and (for split systems) MECH-25 V
R1 III t
2
APPROVED
Reg*0tCf RUC
®kTSa41'o �' 8Y
&� �j
❑ 2. Duct systems with less than 40 linear feet to unconditioned space, or
❑ 3. Existing ducts stems are constructed, insulated or sealed with asbestos
112. 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 -4R forms: MECH 20-, and (for split systems)MECH-22, and MECH 25
new equipment)
For Split Systems: Duct leakage < 6 percent; RC, CCA > 350 CFM/ton, FWD, TMAH, STMS, and either HSPP or PSPP.
For Packaged Units: Duct leakage < 6 percent
❑ 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
❑ 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
❑ EXCEPTION: Existing ducts stems constructed, insulated or sealed with asbestos.
Contractor (Documentation Author's /Responsible Designer's Declaration Statement)
• 1 certify that this Certificate of Compliance documentation is accurate and complete.
• 1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of Compliance.
• 1 certify that the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24,
Parts 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 andspecifications submitted to the enforcement agency for approval with the pe;Kit application.
Name: A I Signature: _ c—
• Condenser Coil and/or
• Indoor Coil and/or CF -6R forms: MECH-2I-HERS and (for split systems) MECH
CF -4R forms: MECH- 21 and (for split systems) MECH-25
• Furnace
For Split Systems: Duct leakage < 15 percent; RC, CCA >_ 300 CFM/ton(Minimum Air Flo
For Packaged Units: Duct leakage < 15 percent
Exempted from duct leakage testing if -
0
£❑ 1. Duct system was documented to have been previously sealed and confirmed through HE
♦1
Company: /i / /I /' /, /, '� Date:
Address: License:
City/State/Zip: t� f//d!�ZZ�—� Phon : ��O/%����i % ��3S
2008 Building Energy Efficiency Standards Residential HVAC Alterations
La Quinta, CA (Climate Zone 15)
BUSINESS AND PROFESSIONS CODE, SECTION 7110
Willful or deliberate disregard and violation of the building laws, including the California Building Code, and local pen -nit
requirements constitutes a cause for disciplinary action from the Contractors State License Board working in conjunction with the
local building department. This action may consist of fines up to $5,000 per violation or suspension/revocation of a contractor's
license.
WHEN IS A PERMIT REQUIRED?
A written construction permit shall be obtained from the enforcement agency prior to the erection, construction, reconstruction,
installation, relocation, or alteration of any mechanical system, except as permitted in Appendix Chapter 1, Section 112.2 of the 2007
California Mechanical Code. Projects requiring permits include, but are not limited to:
• New HVAC installation • Relocation of an existing HVAC unit
• HVAC Changeout
• Replacement of furnace, coil, FAU, or condenser
Adding or replacing more than 40ft ducting
2008 BUILDING ENERGY EFFICIENCY STANDARDS (Title 24, Part 6) REOUIREMENTS INCLUDE:
1. Heating equipment must have a minimum 78% AFUE (Exception: Wall & floor furnaces; room heaters).
2. Centralrair conditioners & heat pumps less than 65,000 Btu/hr must have a minimum 13 SEER.
3. Newly installed orreplacedAucts•must have a minimum insulation value of R-4.2. When more than 40 ft of ducting will be installed
or replaced, the duct insulation value must be R-6 (CZ 10-13), or R-8 (CZ 14 and 15).
4. A setback type thermostat (24 hr clock with four set points) is required for all alterations.
5. New or replacement ducts must meet the mandatory requirements of Section 150(m):
• All joints and openings in the in the HVAC system must be sealed.
• Only UL 181,UL 181A, or UL 181B approved tapes or mastic shall be used to seal duct openings.
• donnections Uffie�dls ducts and the inner core of flex ducts shall be mechanically fastened. Flex ducts must be connected
using a metal sleeve/coupling.
_•'� �FIe7 ducts`that are}suspended must be supported every 4ft. max for horizontal runs with no more than 2" of sag between
-~ suppoits and 6 ft: max-fdr vertical runs.
WHEN IS HERS VERIFICATION REQUIRED AND WHAT FORMS ARE REQUIRED?
HERS verification is required for all HVAC alterations in Climate Zone 10-15. A HERS rater is a special inspector for the building
department. The building inspector may also request to be on site to witness testing by the contractor and/or HERS rater. The installer
picks one of the four options on the CF -IR -ALT -HVAC Form that describe the work being conducted. Each option lists the forms
required to be at the job site for final inspection.
• CF -6R Forms shall be completed and submitted by the installing contractor for final inspection.•
• CF -4R Forms shall be completed, registered with an approved HERS Provider (cannot be completed by hand), and submitted
by the HERS Rater for final inspection effective January 1, 2010.
DESCRIPTION OF HERS TESTS BELOW (Full descriptions found in Residential Appendix RA3 and Residential Manual)
Duct sealing — The installer is to insure leakage of the HVAC system is less than 6% for new air conditioning system (new equipment
and all new ducts) or 15%, 60% reduction, seal all accessible leaks, etc. for alterations to existing HVAC systems. When the
contractor uses the option to seal all accessible leaks, all easily movable objects must be moved to seal existing ducting. New ducting
installed by the contractor is not allowed to have any leaks even if it is no longer accessible. In example 3 of the CF -1 R "all new
ducts" means that all the ducting was changed. The original boots, plenums, etc. do not need to be changed.
Cooling Coil Airflow (CCA) — There are two different minimum air flow requirements that must be met. These are 300 CFM and
350 CFM. The minimum 300 CFM per ton of cooling is required in order to conduct a refrigerant charge test. For new HVAC systems
(new equipment and new ducts) the HVAC system must move a minimum 350 CFM of air for each ton of cooling.
Refrigerant Charge (RC) — The installer is required to verify the charge is correct. If the outside temperature is below 55 degrees
then the weigh in method must be used by the installer. When the weigh in method is used the HERS rater must retest when the
temperature is 55 and above. A charge indicator display (CID) can be used in place of conducting an RC; manufacturers are currently
developing this device.
Temperature Measurement Access Holes (TMAH) — Installer must drill and mark holes to measure temperature split.
Hole for the placement of a Static Pressure Probe (HSPP) or Permanently installed Static Pressure Probe (PSPP) — Either the
installer must drill and mark holes to measure static pressure or a permanently installed pressure probe must be installed and marked.
Saturation Temperature Measurement Sensors (STMS) — Permanently installed type K thermocouple are installed on the indoor
and outdoor coil so that the HERS rater can verify charge without attaching gauges. Instructions are found in Ch 4 of the Res. Manual.
Fan Watt Draw (FWD) — Installer verifies that the furnace fan watt draw is less than 0.58 Watts/CFM.
NOTE: The CF-6R-MECH-04 is required for all HVAC alterations.
* For Final inspection ALL compliance forms (CF -111s, CF -611s, and CF-4I1s) shall be registered with an approved HERS
Provider for building permit applications submitted on or after October 1, 2010.
PROPOSAL
Speedy Ac & Heating
54685 Avenida Herrera
La Quinta, Ca 92253
Lie # 8��471
PROPOSAL SUBMI -ro 1" J i
WORK TO BE PERFORMED AT:
PROPO AL
SHEET NO.
DATE
We hereby propose to furnish the materials and perform the labor necessary for the completion of
lflzhd
da 09
a
oo
01
-elf 5,
i
All materiaris guaranteed specified, and the above work to be performed in accordance with the drawings and specifi-
cations submitted for above work and completed in a substantial workmanlike manner for the sum of
Dollars ($
with payments to be made as follows.
Respectfully submitted
Any alteration or deviation from above specifications involving extra costs
will be executed only upon written order, and will become an extra charge Per
over and above the estimate. All agreements contingent upon strikes, ac-
cidents, or delays beyond our control.
Note —This proposal may be withdrawn
by us if not accepted withins�days.
ACCEPTANCE OF PROPOSAL
The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work
as specified. Payments will be made as outlined above. / ,
Signature
Date 3 17 (O Signature
&' ad— NC 3818-50 PROPOSAL
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4111-MECH-21
Duct Leakage Test - Existing Duct System (Page 1 of 2)
-Site Address: Enforcement Agency: Permit Number:
53710 Avenida Rubio, La Quinta CA 92253 City of La Quinta 10-0221
Enter the Duct System Name or Identification/Tag: main System
Enter the Duct System Location or Area Served: entire 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.
0 1. Measured leakage less than 15% of fan flow
0 2. Measured leakage to outside less than 10% of Fan Flow
p 3. Reduce leakage by 60% and conduct smoke and fix all leaks
0 4. Fix all accessible leaks using smoke and HERS rater verify
Note: (Option 1, 2 OR 3 must be attempted before utilizing Option 4)
Determine nominal Fan Flow using one of the following three calculation methods.
✓ Cooling system method: Size of condenser in Tons 4 x 400 = 1600 CFM
✓ Heating 21.7 Outs` in Thousands Btu/hr;—
system method: x _ put Capacity of CFM
f t.
✓ O
Measured system airflow using RA3.3 airflow testCFM^`
1
Option i used then: - v _
Allowed leakage*": Fa Flo rl 1600 x 0.1 240 GFM4
&
Actual Leakage =''`225"1 CFM �_. ti�.� --� -, x �
l -
/�
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% _ % Reduction
Pass if % Reduction > 60%
Ei Pass Ei Fail
Option 4 used then:
4
All accessible leaks repaired using smoke. HERS rater must verify (No sampling). No smoke
allowed to leak from system. Including ducts, plenums, air handler and door panel.
Pass if all accessible leaks have been repaired using smoke
❑ Pass Fail
1''AJ
Reg: 210-A0004109A-000000000-M21A Registration Date/Time: 2010104108 20:49:17 HERSPRovider: CaICERTS
2008 Residential Compliance Forms August 2009
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:
53710 Avenida Rubio, La Quinta CA 92253 City of La Quinta 10-0221
R 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.
10 All supply,a id-ireturn register boots _must�be sealed-ttoAhe drywaWif, smokettest-.is utilized&r. compliance
- applies,' o`duct leakage complia e option' 3g(leakage reduction'�60%)�and option`4 (fix all accessible
leaks) described above. .
If
0 New duct installations cannot utilize building cavities as plenums platform returns,in,l eu•of ducts-
• Mastic and ,draw bands must be,used.in corribinatior5,with,cloth backedrrubber adhesive)duct tape,bofi seal+
leaks at all new duct connections -''
DECLARATION STATEMENT
. I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct.
• I am the certified HERS rater who performed the verification services identified and reported on this certificate (responsible rater).
• The installed feature, material, component, or manufactured device requiring HERS verification that is identified on this certificate (the
installation) complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified
on the Certificate(s) of Compliance (CF -1R) approved by the local enforcement agency.
• The information reported on applicable sections of the Installation Certificate(s) (CF -6R), 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 -611)
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
SPEEDY AIR CONDITIONING
Responsible Person's Name:
CSLB License:
Daniel Torrez
1834471
HERS Provider Data Registry Information
Sample Group # (if applicable): N/A
Q tested/verified dwelling
❑ not-tested/verified dwelling in
la
HERS sample group
HERS Rater Information CalCERTS Certificate # CC1-1798491129
HERS Rater Company Name:
ALDCOAir
Responsible Rater's Name:
Responsible Rater's Signature:
Rafael Aldaz
Signature on File at CaICERTS, Inc.
Responsible Rater's Certification Number w/ this HERS Provider:
Date Signed: 3/31/2010
CC2004690
Reg: 210-A0004109A-000000000-M21A Registration Date/Time: 2010/04/08 20:49:17 AERSPRovider: CalCERTS
2008 Residential Compliance Forms August 2009
:ERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-2!
tefrigerant Charge Verification - Standard Measurement Procedure (Page i of 5;
Site Address: Enforcement Agency: Permit Number:
53710 Avenida Rubio, La Quinta CA 92253 1 City of La Quinta 10-0221
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
Main System
System Location or Area Served
Entire House
1
pYes
❑ 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 I System
3
,r'
p Yes
tThe
No
sensor is factoryinstalled, ogfieldInstall,ed,accordingto manufacturer's
is`installed by
The sensor is factory installed, or field installed according to manufacturer's
6
❑
specifications?,or methods/specifications approved by,,the Executive
specifications, or is installed by methods/specifications approved by the Executive
. �. !
Director. / A l 1/: / k I -
Director.
The sensor wire is terminated with a standard mini plug suitable for connection to a
4
❑ Yes�j
No/'
digital thermometer. The sensor mini plug is accessible to,the installing technician „
digital thermometer. The sensor mini plug is accessible to the installing technician
/
a .,
and the HERS rater without changing the airflow through ,the condenser coil /
5
-EI Yes-+ 1
"p No..
IThe sensor measures the saturation temperature of the coil within 1:31degrees F ti
Yes to 3, 4, and 5 is a pass. Enter N/A if STMS are not
-7
✓ 8 N/A
✓ ❑Pass
✓ Fail
applicable. Otherwise enter Pass or Fail
applicable. Otherwise enter Pass or Fail
i
STMS - Sensor on the Condenser Coil
System Name or Identification/Tag I System
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
[1Yes
❑ No
The 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
✓ C] Pass
✓ E] Fail
applicable. Otherwise enter Pass or Fail
Reg: 210-A0004109A-000000000-M25A Registration Date/Time: 2010104108 21:01:55 HERSPRovider: Ca10ERTS
2008 Residential Compliance Forms August 2009
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of S)
Site Address: Enforcement Agency: Permit Number:
53710 Avenida Rubio, La Quinta CA 92253 1 City of La Quinta 10-0221
Standard Charge Measurement Procedure (for use if outdoor air dry-bulb is above SS°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) fur
any additional systems in the dwelling as applicable.
• The system should be installed and charged in accordance with the manufacturer's specifications before starting this procedure.
• The system must meet minimum 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 Conditionin4 Svstems
System Name or Identification/Tag
Main System
(must be re -calibrated monthly)
Date of Thermocouple Calibration
,�+�'4-'^.w _..., ` ,�
03/01/2010
"�C�w.+t-^-•�.�.-tet +�"�C""� �
System Location or Area Served
Entire House
Outdoor Unit Serial #
PSDO80401297
Outdoor Unit Make
MAYTAG
Outdoor Unit Model
PSH48DO48
Nominal Cooling Capacity Btu/hr
48000
Date of Verification
03/31/2010
a,a111Jrat10n OF vlagnostic anstrumenrs
Date of Refrigerant Gauge Calibration
03/01/2010
(must be re -calibrated monthly)
Date of Thermocouple Calibration
,�+�'4-'^.w _..., ` ,�
03/01/2010
"�C�w.+t-^-•�.�.-tet +�"�C""� �
(must be re -calibrated monthly)
�—s.�7 .J.�"'t�+
measurea 1 emperatures (,r 1 / f f/ F I V I i V9 1 11 f 1 11
System Name or Identificatio '/Tag? %
Mainlystem
U
Supplyt(evaporator leaving) air dry-bulb
temperature (Tsupp'lyLdb)
Return (evaporator entering) air dry-bulb
temperature (Tretum, db)
70
Return (evaporator entering) air wet -bulb
temperature (Treturn "Wb)
Evaporator saturation temperature
(Tevaporator, sat)
35
Condensor saturation temperature
(Tcondensor, sat)
88
Suction line temperature (Tsuction)
48
Liquid Line Temperature (Tliquid)
75
Condenser (entering) air dry-bulb
temperature (Tcondenser, db)
0
Reg: 210-A0004109A-000000000-M25A Registration DatelTime: 2010/04/08 21:01:55 HERSPRovider: CaICERTS
2008 Residential Compliance Forms August 2009
INSTALLATION CERTIFICATE CF-411-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5)
Site Address: Enforcement Agency: Permit Number:
53710 Avenida Rubio, La Quinta CA 92253 1 City of La Quinta 10-0221
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
Main System
Calculate: Actual Temperature Split = Tretum,
is
db - Tsupply, db
Target Temperature Split from Table RA3.2-3
16.5
using Treturn, wb and Treturn, db
Calculate difference: Actual Temperature Split -
1.5
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 Identification/Tag
Calculated Minimum)Airflow Requirement (CFM)
f
V'•
f.
r
t
,,��
Measured Airflow using'}'RA3.3 procedures (CFM)
It
/ I
I
,- / f '/ , / I k A,
--
Passes if, measured -airflow is greater than oft—
ft
equal
equal to the calculated minimum airflow
requirement.
Enter Pass or Faill
Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is required to be used
for fixed orifice metering device systems
System Name or Identification/Tag
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 Fal
Reg: 210-A0004109A-000000000-M25A Registration Date/Time: 2010104108 21:01:55 HERSPRovider: CalcERTs
2008 Residential Compliance Forms August 2009
INSTALLATION CERTIFICATE CF-4R-MECH-25
2efrigerant Charge Verification - Standard Measurement Procedure (Page 4 of SJ
Site Address: Enforcement Agency: Permit Number:
53710 Avenida Rubio, La Quinta CA 92253 1 City of La Quinta 10-0221
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
Main System
Calculate: Actual Subcooling =
13
Tcondenser, sat - Tliquid
Target Subcooling specified by manufacturer
16
Calculate difference:
-3
Actual Subcooling - Target Subcooling =
System passes if difference is between
-4°F and +4°F
PASS
Enter Pass or Faill
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
Main System
Calculate: Actual Superheat =
13
Tsuction - Tevaporator; sat
Enter allowable superheat range from
manufacturer's specifications (or use range
10
between 3°F and 26°F if manufacturer's
specification isnot available)
System passes if actual superheat is within the
allowable superheat range _
Enter Passor Fail'
PASS
f
Reg: 210-A0004109A-000000000-M25A Registration Date/Time: 2010/04/08 21:01:55 HERSPRovider: CaICERTS
2008 Residential Compliance Forms August 2009
r V
INSTALLATION CERTIFICATE CF-4R-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5)
Site Address: Enforcement Agency: Permit Number:
53710 Avenida Rubio, La Quinta CA 92253 City of La Quinta 10-0221
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
Main System
1834471
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
ALDCOAir
Responsible Rater's Name:
Responsible Rater's Signature:
Enter Pass or Fail
Signature on File at CaICERTS, Inc.
Responsible Rater's Certification Number wl this HERS Provider:
Date Signed: 3/31/2010
CC2004690
r - —
DECLARATION STATEMENT
. I certify under penalty. of perjury, Linder 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 -611)
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
SPEEDY AIR CONDMONING
Responsible Person's Name:
CSLB License:
Daniel Torrez
1834471
HERS Provider Data Registry Information
Sample Group # (if applicable): N/A
Q tested/verified dwelling
❑ not-tested/verified dwelling in
la
HERS sample group
HERS Rater information CalCERTS Certificate # CCI -1798491129
HERS Rater Company Name:
ALDCOAir
Responsible Rater's Name:
Responsible Rater's Signature:
Rafael Aldaz
Signature on File at CaICERTS, Inc.
Responsible Rater's Certification Number wl this HERS Provider:
Date Signed: 3/31/2010
CC2004690
Reg: 110-A0004109A-000000000-M25A Registration Date/Time: 1010104108 21:01:55 HERSPRovider: CaICERTS
2008 Residential Compliance Forms August 2009