10-0518 (MECH)•41
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 '
Application Number: 10-00000518__;
Property Address: '--%52.962 AVENIDA RAMIREZ
APN: 773-323-011-16 -000000-
Application description: MECHANICAL
Property Zoninq: COVE RESIDENTIAL
Application valuation: 7000
'Applicant:
J l ,
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
- - -` -A-�-_Architect or Engineer.
PIa&
------------------
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 License No.: 918073
ntiactor:
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 1$5001.:
(_ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and 40
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 1, 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 '
Dater
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
Owner:
STEVE FLANIGAN
52962 AVENIDA-RAMIREZ
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/15/10
lu d
_..Contractor:. - -.... _ .. .-. _.... ....._
SHIMP AIR COND & H G'INC„ P1HIL
80530 VIRGINIA AV NUE"Ufc
INDIO, CA 92201 ttrr�
(760) 342-3908
Lic. No.. 918073 ..
------------------
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 NORGUARD INS Policy Number PHWC015707
_ I 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 Cndeal//o�rthh ith comply with those provisions.
Uate:� plicant: �1��y.
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 an state laws relating to building construction, and hereby authorize representatives
/th',.s,,,cu/nty to enterupo above-mentioned property ins ec ' urposes.
� lv gnature (Applicant or Agent)'
r
LQPERMIT - .
Application Number 10=00000518
Permit . . . MECHANICAL
Additional desc .' .
Permit Fee . . . . 33.00 Plan Check Fee
8.25
Issue -Date . . . . Valuation
0
Expiration,Date 12/12/10
Qty Unit Charge' Per
Extension
BASE FEE'
15.00
1.00 9.0000 EA MECH FURNACE <=100K
9.00
1.00 9.0000 EA MECH B/C <=3hp/ 1UUA 13-1-U
9.00
----------------------------------------------------------------------------
Special Notes and Comments
-NEW INDOOR COIL_ &. CONDENSING - - : — .... ._ _.
_.. ................ ....:... ... ..... - -- ---
UNIT (15 SEER). 2007 CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary -Charged Paid Credited
Due
Permit Fee.Total 33.00 .00 .00
33..00
Plan Check Total 8.25 .00 .00
8.25
Other Fee Total 1.00 00 .00
1.00
- Grand Total 42.25 .00 .00
42.25
r
LQPERMIT - .
LQPERMIT - .
Simplified Prescri f
Climate Zones• 10 to 15
Site Address:
s2 4C,!I_ t",
Certificate of
a
2008 Residential HVAC Alteradons
CF -IR -ALT -HVAC
-15-149
.tinned Floor
wt mtntmum mncten - Duct insulation requirement Area Thertnostat
❑ Packaged Unit
❑ Furnace ❑ AFUE ❑ COP Over 40 ft of ducts added or ULSeftck
Wridoor. Coil GSEER 1 5 ❑ HSPF replaced in unconditioned space Served 1by syr Of not already
G,Condensing Unit O EER N_Resistance ❑ R 6 (CZ 10-13) /s sf present must be
❑ Other ❑ R 8 (Q 14-15) innalled)
/.Equipment Type: Choose the equipment being installed: i] -more than one system, use another CF -1 R-ALT-HFACfor each system.
1. Minimum Equipntetrt E,04ckwcky: 13 SEER, 7846 AFUE, 7.7HSPF for typwa1 residential systems.
HERS VERIFICATION SUMMARY Listed below ate fatty HVAC alteration Options. The installer dedoes what wok 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 fad the work completed by the
installer. The inspector also verifies that each appropriate CF -6R and registered CF4R fortes (no hand filled CF4Rs allowed) are filled out and
signed. Beginning October 1, 2010, a registered COPY of the CF -IR and CF4R diall also be on dte for &ruin tnapeetiost.
W HVAC Chanoeout e.....t� F
• All HVAC Equipment replaced
• Condenser Coil and/or
• Indoor Coil and /or
orms.
forms: MECH•04, MECH-21-HERS and (for split system)
fortes: MECH- 21 and (for split svctemcl to rt`m--c
CF-iR forms: MECH-2I-HERS and (for split systems) MECH. 25 -HERS
• turnace CF -4R fortes: MECH- 21 a� (for split systems) MEC11-25
For Split Systems: Duct leakage < 15 percent; RC, CCA > 300 CFMA*Minimum Air Flow RequL-enent), 'IMAH
For Packaged Units: Duct leakage < 15 percent
Exempted from duct leakage testing if:
❑ 1 Duct system was documented to have been previously sealed and otmfirmed through HERS verification, or
❑ 2. Duct systems with less than 40 linear feet in unconditioned space, or
❑ 3. Exiging duds stems are constructed,insulated or sealed with asbestos
❑ 2. New HVAC System Required Forms:
• Cut in or Changeout with new
duds: (all new ducting gm all CF -6R forms: MECH-04, MECH-20-HEBS,and (for split systems) MECH-22-HERS, and MECH-25-HERS
new equipment) CF4R forms: MECH 20-, and (for splitsystems)N(ECH-22, and MECH 25
For Split Systems: Dud leakage < 6 percent RC, CCA > 350 CFMRon, FWD, TMAH, SIMS, and either HSPP or PSPP.
For Packaged Units: Duct leakage <6 percent
❑ 3. New Ducts with Replacement
• Includes replacing or installing all new ducting CF -611 forms: MECH-04, MECH-20-HERS,and (for splk systems) MECH-25-HERS
and/or outdoor condensing unit and/or indoor CF -4R forms: MECH-20 and (for split systems) MECH-15
coil and/or furnace. Not all equipment changed.
For Split Systems: Duct leakage < 6 percent, RC, CCA >_ 300 CFM/ton, TMAH
For Packaged Units: Dud leakage < 6 percent
❑ 4. New Ducting over 40 feet Required Forms:
• Includes adding or replacing more than 40
ce. CF -6R forms: MECH-04, MECH-2l-HERS . CF -4R forms: MECH-21
linear feet of duct in unconditioned s
For split system or packaged units: Duct—leakage < 15 percent
❑ EXCEPTION: Existing duct systems oottsttucted, 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 ten ilk, that the energy features and performance s. ifications for the design identified on this Certificate of Compliattce conform to the requirements of Tide 24,
Peru 1 and 6 of the California Code of Regulations.
• _ i h,: design features identified on this Certificate of Compliance are consistent with the information documented on otter applicable compliance fonts, wodmheets_
calculations, Plans and specifications submitted to the enforcement icy for &=oval with the it applicaWn.
�i\,r n /
V \ Tf lei SignalWe: t
Company:
e --
Address
City/State/Zip:.;
Dace:
6, -IS -10
zvvo «estaennat c=ompliance Forms March 2010
Bin #
Qty of LQ 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 #
Project Address: t
rOwner'.s.Name: e V
A. P. Number.
Legal Description:
Contractor: i
"Address:»CIOV` ,^� -R—
Telnc.p q , 5
.Wo , e:_
on: (C C�Cy.v\ OV
City, ST,fZip: S @
�elepfiori� 7�t9 3�l'�-316$ ,
•
City Lic: C
Arch., Engr., Designer.
Address:
City., ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:
Construction Type: Occupancy;
Project type (circle one): New Add'n Alter Repair Demo
Sq. Fk:
#Stories:
#Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
H
Submittal
Req'd
Recd
TRACKING
IPERMrr FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cases.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Cales.
Plans picked up'
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2'' Review, ready for corrections/issue
Electrical
Subcoutactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
3" Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total PermitFees
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF-4R-MECH-21
Duct Leakage Test — Existing Duct System (Pae 1 of 2)
Site Address: .,. Enforcement Agency: Permit Number:
_52-962-AvenidawRamirez;La Quinta,CA92253 I City of La Quints 110518
Enter the Duct System Name or Identification/Tag: House Zone
Enter the Duct System Location or Area -Served: Whole House
Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the dwelling.
This installation certificate is required for compliance for alterations and additions in existing dwellings to space
conditioning systems and duct systems. 10
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 Lenkaue Diaunnetir TPet — i-viefina dart evefam 11' �,
Select one compliance method from the following tfo��ho
Option 1. Measured leakage less than 1`5% of Fan ,flow.
Option 2. Measured leakage to outside%less thandl'0% of Fan*Airflow:
Eloption 3. Reduce leakage by 60% or more,l'and conduct smoke test to seat all accessible leaks.
`g
oke�test,
Option 4. Fix all accessible leaks using -s- and HERS rater mustt verify.
Note: (Option 1 must be attempted before=utilizing Option 4)!
Determine nominal Fan Airflow using one oftWfollowingfthree•calcculation methods.
✓ ooling system method: Size in Tons 4 =1600
of condenser �fx 400 CFM
beating system method: 21.7 x 0 Meatmg Output Capacity =
(kBtuh) CFM
wleasured system airflow using RA3.3 airflow test procedures: CFM
I t I i i
1
Option 1 used thewomaiv r
Allowed leakage Fj�an Airflow 11 .60, 9:ILUC.I5 =. 239C CFM
Actual leakage = 125► F I I ,
Pass if Actual leaks a is less than Allowed leakage
R]PasEl Fail
Option 2 used then:
Allowed leakage = Fan Airflow x 0.10 = CFM
2
Actual leakage to outside = CFM
Pass if Actual leakage to outside is less than Allowed leakage
nasd_-JlFail
Option 3 used then:
Initial leakage priorito start of work= 0 CFM
Final leakage after sealing all accessible leaks using smoke test = 0 CFM
3
Initial leakage 0 - Final leakage 0 = Leakage reduction 0 CFM
(Leakage reduction 0 /Initial leakage 0 ) x 100% _ % Reduction
Pass if % Reduction > 60%
11passnail
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 sealed using Smoke Tes
1 as
Registration Number: 110-F19BCF45-0050-1-MECH21 Registration Date/Time: 07/08/2010 11:40 HERS Provider: CHEERS
u
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF-4R-MECH-21
Duct Leakage Test — Existing Duct System (Page 2 of 2)
Site Address: I Enforcement Agency: Permit Number:
52-962 Avenida Ramirez,La Quinta,CA922531 City of La Quinta 110518
❑ Outside air (OA) ducts for Central Fan Integr.ated.(CY) ventilation, systems; shall not be sealed/taped off duringAuct
leakage testing. CFI OA ducts that utilize controlled mot4i2eeed dampers; that open only when OA ventilation is required to
meet ASHRAE Standard 62.2, and close when OA ventilafiona�s1 not required, may be configured to the closed position
during duct leakage testing.'
❑ All supply and return register boots must be sealed to the d ~
pP Y 9 rywall ►f smoke test is utilized for compliance — applies to
duct leakage compliance option 3 (lea`age}reduction by 60%),and`_option 4ZS__,(�fix all accessible leaks) described above.
❑ New duct installations cannot utilize.building cavities as plenumsor platform returns in lieu of ducts.
❑ Mastic and draw bands must be used`incombiinaat on with cloth�backed,rubber adhesive duct tape to seal leaks at all new
duct connections..
DECLARATION STATEMENT -4:Z1,
• I certify under penalty of perjury, under the laawK the State of California, the information provided on this form is true and correct.
• I am the certified HERS rater who performed the- erifica ion,services identified and reported on this certificate (responsible rater).
• The installed feature, material, component, or manufaetured.device)ergwnng 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 oapplicable secti$n s of the nstallatio a ilcate(s) CF -6R), signed4nd submitted by the person(s)
re
responsible for the installation conforms to t)i� qui ments speeiori the Certificate(s) of*Compliance (CF -IR) approved by the
enforcement agency. WON4
1 I I tLW 1�
Builder or Installer informationn_s�sh`owhton the IAtallit►on (lerfifi:eate iCFp6R * -.1 #ALW
Company Name: (Installing Subcontra6tor or General IContractor ,pr Builder/Owner) l
Phil Shimp Air Conditioning
Responsible Person's Name:
CSLB Licenser
Ruben Orozco
1918073
HERS Provider Data Re ist Information
N/Ale Group # (if applicable): ✓ ested/verified dwelling not-tested/verified dwelling
HERS
in a sample group
HERS Rater Information
HERS Rater Company Name:
Energy Management Services
Responsible Rater's Name
Jack LaFontaine
Responsible Rater's Signature
Jack LaFontaine(Signature on File)
Responsible Rater's Certification Number w/ this HERS Provider:
Date Signed:
CCNJ L348610
7/8/2010
Registration Number: 110-F19BCF45-0050-1-MECH21 Registration Date/Time: 07/08/2010 11:40 HERS Provider: CHEERS
•h
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF-4R-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 5)
Site Address: I Enforcement Agency: Permit Number:
52-962 Avenida Ramirez,La Quinta,CA92253 City of La Quinta10518
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
Zone HVAC
Zone HVAC
3
E]Yes
ENO
System Location or Area Served
y
[]No
Whdte,Hjouse;
�
Director.
4
[]Yes
o-
,The sensor wire is terminated with a standard mini plutgisuitable for connection to a
digital thermometer-; The sensor mi- lug is accessE le to the installingtechnician and
Director.
7
1
[]Yes
ao
5/16ji4 M (8 mm) }cress hole up� U�eam of evaporative coil in the return plenum and .
I
re, sensor rneadstres the sa uratign tem erp attire of the coil within 1.3 degrees F
Yes to 3, 4, and 5 is a pass. i I Enter
N/A if STMS are not applicable. Otherwise enter Pass or Fa
-Yil ® N/A I [] Pass
Iabelerjaccording� EgureLn,SectronlRA3.2.2.2.2.
2
Wes
Do
5%1-6r nch'(8 mm) access`hole'dow'�nstream of evaporative coil in the supply plenum
Yes
Do
The sensor measures the saturation temperature of the coil within 1.3 degrees F
and'labeled�aceordmg to�F�i'gure�in Section RA3.2.2.2.2.
Yes to 1 and 2 is a pass.
lEnier-Pass�or Fail ✓
�^' {,'. � ,� _ QPass -0' [:]Fail
STMS - Sensor on the Evauorator Coil t
System Name or Identification/Tag Zone HVAC'
Zone HVAC
3
E]Yes
ENO
The sensor is facto*ry' inskilled, or -field installed according to manufacturer's
specifications, oras installed by, methods/specifications approved by the Executive
[]No
The sensor is factory installed, or field installed according to manufacturer's
Director.
4
[]Yes
o-
,The sensor wire is terminated with a standard mini plutgisuitable for connection to a
digital thermometer-; The sensor mi- lug is accessE le to the installingtechnician and
Director.
7
the' E rater ut! ch g ng�thdA- r w thro ghthe condenser co
5
1 []Yes
Eloy�T
re, sensor rneadstres the sa uratign tem erp attire of the coil within 1.3 degrees F
Yes to 3, 4, and 5 is a pass. i I Enter
N/A if STMS are not applicable. Otherwise enter Pass or Fa
-Yil ® N/A I [] Pass
✓ []Fail
STMS - Sensor on the Condenser Coil
System Name or Identification/Tag
Zone HVAC
6
[]Yes
[]No
The sensor is factory installed, or field installed according to manufacturer's
specifications, or is installed by methods/specifications approved by the Executive
Director.
7
[]Yes
[]No
The sensor wire is terminated with a standard mini plug suitable for connection to a
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
Do
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 applicable. Otherwise enter Pass or FailN/A
✓ []Pass
✓ []Fail
Registration Number: 110-F1913CF45-0050-1-NIECH25 Registration Date/Time: 07/08/2010 11:40 HERS Provider: CHEERS
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF-4R-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5)
Site Address: Enforcement Agency: Permit Number:
52-962 Avenida Ramirez,La Quinta,CA92253 City of La Quinta 10518
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 forms) 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 'For below, the installer must use the Alternate Charge Measurement Procedure.
Snace Conditioninu Svctems
System Name or Identification/Tag
Zone HVAC
(must be re -calibrated monthly)
Date of Thermocouple Calibration
7�6�2r0� O�
System Location or Area Served
Whole House
Outdoor Unit Serial #
9432 R Ca L2 F
Outdoor Unit Make
Trane
�.
Return (evaporator entering air dry -b lbLIMA=
14
Outdoor Unit Model
4TW R50481,000 A,'
U
.0
Nominal Cooling Capacity Btu/hr'
48D -0�
et
Date of Verification
7V6,12.01`
-d
n �*�.
��
Cnlihrntinn of T)inannetir 1netrumante rt
Date of Refrigerant Gauge Calibration
7/6/201.0
(must be re -calibrated monthly)
Date of Thermocouple Calibration
7�6�2r0� O�
(must be re -calibrated monthly)
Measured Temneratures OM
System Name or Identification/Tag
Zone HVAC
Supply (evaporator leaving)%ir-dry Abu •b,
temperature(Tsu 1 , db) 1;'
l='
/ •�5�
Return (evaporator entering air dry -b lbLIMA=
14
L=
U
.0
temperature (Tretum,
Return (evaporator entering) air. wet -bulb
��
temperature (Tretum, wb)
Evaporator saturation temperature
��
(Teva orator sat)
Condensor saturation temperature
J 08
1
(Tcondensor, sat)
Suction line temperature (Tsuction)
64
Liquid Line Temperature (Tliquid)
88
Condenser (entering) air dry-bulb
��
temperature (Tcondenser, db)
Registration Number: 110-F1913CF45-0050-1-MECH25 Registration Date/Time: 07/08/2010 11:40 HERS Provider: CHEERS
I
• ti-Y'i-fSO
:JgN•u!..�,t }I;:.i',• � ,��e"�iltt''�C.t14�../21
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF-4R-MECH-25.
Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5)
Site Address: I Enforcement Agency: Permit Number:
52-962 Avenida Ramirez,La Quinta;CA922531 City of La Quinta 110518
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
Zone HVAC
Calculate: Actual Temperature Split =
i8.9
Tretum, db - Tsupply, db
Target Superheat from Table RA3.2-2
Target Temperature'Split from Table
22.1
RA3.2-3 using Tretum, wb and Treturn, db
Calculate difference: Actual Temperature
'
Split — Target Temperature Split =
Passes if difference is between -4°F and
+4°F or upon remeasurement, if between
f aSS
\
-4°F and -100°F , Enter Pass or Fiiil.•
rlik
Note: Temperature Split Method Calculation is Fnot necessary i, *actual Cooling Coil Airflow is verified using one of the
b-b1t1 01.t.r1
airflow in Reference
measurement procedures specified Res' ent:al�Ap -en ix RA 3.3. If actual cooling coil airflow is
measured the value must be equal to or gra atertha`n the Calcula ed Min• eum Airflow Requirement in the table below.
Capacity
Calculated Minimum Airflow Requirement -,(CFM) Nomi nal.Cool ng (ton) X 300 (cfm/ton)
,/ 4..,
System Name or Identification/Tag
,
ZO e HVAC
t
Calculated Minimum Airflow
Requirement (CFM)
.010h-� W.
Measured Airflow using R -A.•3.3
rocedurasFM
Passes if measured airflow is greater than
l I
I I
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
Zone HVAC
Calculate: Actual Superheat =
Tsuction — Teva orator sat
Target Superheat from Table RA3.2-2
using Tretum 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
r
Registration Number: 110-F1913CF45-0050-1-MECH25 Registration Date/Time: 07/08/2010 11:40 HERS Provider: CHEERS
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF-4R-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure . (Page 4 of 5
Site Address: I Enforcement Agency: Permit Number:
52-962 Avenida. Ramirez,La Quinta,CA92253 I City of La Quinta 110518
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
Zone. HVAC
0g,
Calculate: Actual Subcooling =
20
Pk
Tcondenser, sat — Tli uid
bT►, ,i, ,,
Target Subcooling specified by
♦ 7
manufacturer
I
Calculate difference:
^
3
Actual Subcooling— Target Subcooling=
System passes if difference is between
�Pass .,
-4°F and +4°F Enter Pass or Fail
Pass
Metering Device Calculations for Refrigerant ChargelVerification. This procedure is required to be used for
thermostatic expansion valve (TXV) and electronic expansicq v41ve (EXV) systems.
�
System Name or Identification/Tag
-
' �one,tH`1 pp/Any
0g,
Calculate: Actual Superheat =�5`��
Pk
Tsuction — Teva orator sat
bT►, ,i, ,,
Enter allowable superheat range from
3-20(;deg F) w
manufacturer's specifications (or use range
between YF and 26°F if manufacturer's'
s ecification is not available)
System passes if actual superheat is within
�Pass .,
the allowable superheat range
.
Enter Pass or Fail
, _ ,. e
0
Registration Number: 110-F19BCF45-0050-1-MECH25 Registration Date/Time: 07/08/2010 11:40 HERS Provider: CHEERS
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF-4R-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 5)
Site Address: I Enforcement Agency: Permit Number:
52-962 Avenida Ramirez,La Quinta,CA92253 City of La Quinta 10518
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
Zone HVAC
1918073
HERS Provider Data Registry Information
Group (if applicable):
SampN/A
System meets all refrigerant charge and
PASS
in
m a HERS sample group.
airflow, requirements. Enter Pass or Fail
HERS Rater Company Name:
Energy Management Services
Responsible Rater's Name
Responsible Rater's Signature
DECLARATION STATEMENT
J
• I certify under penal tyof a u ry, under the laws ofothState`o"f Californ
ia, 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 ddvice requiring HERS verification th is identified on this certificate
(the installation) complies eith he apph eirreequ�reme sin Reference tesidenfial Appen ces RA2 and RA3 and the requirements
" i ,t "� i" is
specified on the Certifi e(s) of Comp l�ianee+(CF-1R) a roved by th local enforcement age�r�cy.
The information reported o .applicatble section o Ithe Id 'ns .tall pion -eertificate(s (C�}F-6R),. gn�d and submitted by the person(s)
responsible for the installation conf §rms to the req irements s�ec"fied on the Certificatir(s) of Compliance (CF -1 R) 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)
Phil Shimp Air Conditioning
Responsible Person's Name:
CSLB License:
Ruben Orozco
1918073
HERS Provider Data Registry Information
Group (if applicable):
SampN/A
✓ tested verified dwelling
i not-tested/verified dwelling
in
m a HERS sample group.
HERS Rater Information
HERS Rater Company Name:
Energy Management Services
Responsible Rater's Name
Responsible Rater's Signature
Jack LaFontaine
Jack LaFontaine(Signature on File
Responsible Rater's Certification Number w/ this HERS Provider:
Date Signed:
CCNJL348610
7/8/2010
Registration Number: 110-F19BCF45-0050-1-N 4ECH25 . Registration Date/Time: 07/08/2010 11:40 HERS Provider: CHEERS