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12-0127 (MECH)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: .12-00000127 Property Address: 78635 BOTTLE BRUSH DR APN: 646-312-013-63 -000000- Application description: MECHANICAL Property Zoning: MEDIUM DENSITY RES Application valuation: 6000 Applicant: Architect or Engineer: 4 4-Q�AAI BUILDING & SAFETY DEPARTMENT BUILDING PERMIT ------------------ ------------------------------ CENSED C RACTOR'S DECLARATION I hereby affirm under penalty of perjury hat I am li sed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business a rofessionals Code, and my License is in full force and effect. . License C ss: Jg20 License No.: 725283 Date: Z 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.). (_) 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 Owner: SMITH RESIDENCE 78635 BOTTLEBRUSH DR LA QUINTA, CA 92253 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 2/13/12 Contractor: � AIR EXPERTS AIR CONDITI,Q -HTG /A\ PO BOX 94 LA QUINTA, CA 92247 +� I (760) 777-1724 , 6 4-�1 ,_ v2012 Lic. No.: 725283 jil ITY`1Es �r g;sIVYA —-------——------------------------------------- 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 GUARD INS GROUP ber PAWC226751 _ I certify that, in the perf ance of the work fo hich this permit is issued, I shall not employ any person in any mann so as to becomes t to the workers' compensation laws of California, d agree that, if I ould beco lect to the workers' compensation provisions of Section 700 of the Labor C \ I forthwith comply with those provisions. Date: 41 Z Applicant: — WAR ING: 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, indemnity 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 p , or cesse of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that a above informatio ' correct. 1 agree to comply with all city and c unty rdmances and state laws relating to building constru ' ,and hereby authorize representatives of this c my enter upon the above-mentioned property fqr in coon purposes. Dat 2 Signature (Applicant or Agentl: / 2 LQPERMIT Application Number . . . . . 12-00000127 Permit . . . MECHANICAL Additional desc . Permit Fee 24.00 Plan Check Fee 6.00 Issue Date . . . . Valuation 0 Expiration Date 8/11/1.2 Qty Unit Charge Per Extension BASE FEE 15.00- 5.001.00 1.009.0000 EA MECH B/C <=3HP/100K BTU 9.00 ---------------------------------------------------------------------------- Special Notes and Comments REPLACE HEAT PUMP A/C & AIR HANDLER 16.0 SEER 9 HSPF ------------------------------------------=------------------- Other Fees . . . .. . . BLDG SIDS ADMIN (SB1473) -------------- 1.00 Fee summary Charged -------------------- Paid Credited -------------------- Due ----------------- Permit Fee Total 24.00 .00 .00 24.00 Plan Check Total 6.00 .00 .00 6.00 . Other Fee Total 1.00 .00 .00 1.00 Grand Total 31.00 .00 .00 31.00 2 LQPERMIT Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC Alterations CF -IR -ALT -HVAC Climate Zones 10 - 15 Site Address: Enforcement Agency: Date: Permit #: 78-635 Bottlebrush Dr. La Quinta, CA 92253 City of La Quinta Feb 13, 2012 Duct insulation Conditioned Floor Equipment Typel List Minimum Efficiency2 requirement Area Thermostat ❑ Package Unit 0 Furnace 0 Indoor Coil ❑ AFUE 0 SEER 16.0 ❑ COP 0 HSPF _ ❑ R 6 (CZ 10-13) Served by system 0 Setback If not already present, must be 0 Condensing Unit [3 EER ❑ Resistance ❑ R 8 (CZ 14-15) 1600 sf installed) ❑ Other 1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -1R -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 -611 and registered CF -411 forms (no hand filled CF-4Rs allowed) are filled out and signed.Beginning October 1, 2010, a registered copy of the CF -IR and CF -611 shall also be on site for final inspection. 0 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 I11NOand (for split systems) MECH-25 • Condenser Coil and /or • Indoor Coil and /or CF -611 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 G.-- P....1.aged Units- f1...-4 leakage 4 15 ..M p 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 [14. Theysystem•will not be Ducted (ie. Ductless Mini -Split System),(Also Exempt from miRefrigerant Charge) ❑ 2. New HVAC System Required Forms: F j a it v iI 4 . Cut inlor Changeout with-'-'CF'-6R new ducts: (all new ' forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-22-HERS, and ducting all new MECH-HERS j� Q CF -4R forms: MECH 20, and (for split systems) MECH-22, and MECH-25 f equipment) %f% /f _ �f _� �•- 4 11 .%/ J . I' 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 -611 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 -61k 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: Paul Van Vlymen Signature: Poul Van Vlymen Company: AIR EXPERTS AIR CONDITIONING -HEATING Date: Feb 13, 2012 Address: PO BOX 94 License: 725283 City/State/Zip: LA QUINTA / CA/ 92247-0094 Phone: (760) 777-1724 Reg: 212-A0007827A-00000000-0000 Registration Date/Time: 2012/02/13 11:30:48 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms July 2010 of Lid Q ` to Building 8t Safety Division P.O. Box 1504,,78-495 Calle Tampico A. La.Quinta, CA 92253 -:(760) 777-7012 Building Permit Application and Tracking Sheet Permit # - Project Address: 7� &—,-rZ6D4 Owner's Name:. A. P. Number. Address: . Legal Description: City, ST, Zip: La C S 2ZS� Contractor. ^ t r' t �X>0£—�� ' ME,...k >. Telephone: Address;?C 91-( Project Description: City, ST, Zip: eA- 9 Telephone: Z(o /72 ;? Q %rC'' State Lic. # : Lie. #: Arch., Engr., Designer. Address: City., ST, Zip: Telephone: State Lic. #: » Name of Contact Person: �j4n/E Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo Sq. Ft.: #Stories:. T- units: Telephone # of Contact Person: Estimated Value of Project: Ck�O APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKNG PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cales. Reviewed, ready for corrections Plan Check Deposit. . Truss Calcs. Called Contact Person Plan Check Balance Title 24 Cala. Plans picked up Contraction Hood plain plan Pians resubmitted.'. Mecharilcal Grading plan 2'a Review, ready for correctiionsfissue Electrical Subcontactor List Carted Contact Person Plumbing Grant Deed Plans picked up SALL H.O.A. Approval Plans resubmitted Grading IN HOUSE:- '^' Review; ready for correctionsAmue Developer Impact Fee Planning Approval Called Contact Person A.I.P-P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees INSTALLATION CERTIFICATE CF-6R-MECH-04 Space Conditioning Systems, Ducts and Fans (Page i of 2) Site Address: 78-635 Bottlebrush Dr., La Quinta CA 92253 (System Enforcement Agency: Permit Number: 1) City of La Quinta 12-127 Space Conditioning Systems Heating Equipment Equip Type (package- heat pump) CEC Certified Mfr. Name and Model Number ARI Reference Number2 # of Identical Systems Efficiency (AFUE, etc.)1, 3 (>=CF -IR value)4 Duct Location (attic, crawl- space, etc.) Duct R -value Heating Load (kBtu/hr) Heating Capacity (kBtu/hr) Split Heat Pump MAYTAG B4VM-X48K-C 4806477 1 9 HSPF IAttic R-4.2 / 7 [ �, 4 Tons 10 Cooling Equipment Equip Type (package heat pump) CEC Certified Mfr. Name and Model Number ARI Reference Number2 # of Identical Systems Efficiency (SEER and EER) 1, 3 (>=CF -1R value)4 Duct Location (attic, crawl- space, etc.) Duct R -value Cooling Load (kBtu/hr) Cooling Capacity (kBtu/hr) Split", Heat Pump \'7MAYTAG CSH4BF048KA �� 4806477 r-'-"~ 1 116'SEER-N i 12.5,EER Attic R!4.211 / 7 [ �, 4 Tons 10 1. If project is new construction, see Footnotes to Standards Table 151-B and Table 151-C for duct ceiling alternative compliance. 2. ARI Reference Number can be found by entering the equipment model number at http://www.aridirector-y.orglarilac.php# 3. Listed efficiency on this page must be greater than or equal ( ? ) to the value shown on the CF -11? form. 4. When CF -1R is reference it is also applicable to the CF -IR, CF -IR -AA or CF -IR -ALT ALL BOXES MUST BE CHECKED TO BE A VALID FORM ® §110-§113: HVAC equipment is certified by the California Energy Commission. ® §150(h): Heating and/or cooling loads calculated in accordance with ASHRAE, SMACNA, or ACCA. ® §150(i): Setback Thermostat on all applicable heating and/or cooling systems meet the requirements of §112(c). ® §150U)2: Pipe insulation for cooling system refrigerant suction, chilled water and brine lines meets minimum requirements of Table 150-B and includes a vapor retardant or is enclosed entirely in conditioned space. 0 Reg: 212-A0007827A-M0400001A-0000 Registration Date/Time: 2012/02/16 12:00:12 HERS Provider: CalCERTS, Inc. - 2008 Residential Compliance Forms August,2009 INSTALLATION CERTIFICATE CF-6R-MECH-04 Space Conditioning Systems, Ducts and Fans (Page 2 of 2) Site Address: 78-635 Bottlebrush Dr., La Quinta CA 92253 (System Enforcement Agency: Permit Number: 1) City of La Quinta 12-127 Ducts and Fans §150(m): Duct and Fans 0 1. All air -distribution system ducts and plenums installed, sealed and insulated to meet the requirements of CMC Sections 601, 602, 603, 604, 605 and Standard 6-5; supply -air and return -air ducts and plenums are insulated to a minimum installed level of R-4.2 or enclosed entirely in conditioned space. Openings shall be sealed with mastic, tape or other duct -closure system that meets the applicable requirements of UL 181, UL 181A, or UL 1818 or aerosol sealant that meets the requirements of UL 723. If mastic or tape is used to seal openings greater than 1/4 inch, the combination of mastic and either mesh or tape shall be used; and 0 1. Building cavities, support platforms for air handlers, and plenums defined or constructed with materials other than sealed sheet metal, duct board or flexible duct shall not be used for conveying conditioned air. Building cavities and support platforms may contain ducts. Ducts installed in cavities and support platforms shall not be compressed to cause reductions in the cross-sectional area of the ducts. 0 2D. Joints and seams of duct systems and their components shall not be sealed with cloth back rubber adhesive duct tapes unless such tape is used in combination with mastic and draw bands. 0 7. Exhaust fan systems have back draft or automatic dampers. 0 8. Gravity ventilating systems serving conditioned space have either automatic or readily accessible, manually operated dampers. 0 Protection of Insulation. Insulation shall be protected from damage, including that due to sunlight, moisture, equipment maintenance, and wind. Cellular foam insulation shall be protected as above or painted with a coating that is water retardant and provides shielding from solar radiation that can cause degradation of the material. 0 10. Flexible,ducts cannot have porous,inner cores. /j . f7 DECLARATION STATEMENT . I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. . I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized representative of the person responsible for construction (responsible person). . I certify that the installed features, materials, components, or manufactured devices identified on this certificate (the installation) conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the enforcement agency. . I reviewed a copy of the Certificate of Compliance (CF -111) form approved by the enforcement agency that identifies the specific requirements for the installation. I certify that the requirements detailed on the CF -111 that apply to the installation have been met. . I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the building owner at occupancy. Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) Air Experts Air Conditioning Responsible Person's Name: Responsible Person's Signature: Paul Van Vlymen Paul Van Vlymen CSLB License: 725283 Date Signed: 2/14/2012 Position With Company (Title): Reg: 212-A0007827A-M0400001A-0000 Registration Date/Time: 2012/02/16 12:00:12 HERS Provider: Ca10ERTS, Inc. 2008 Residential Compliance Forms August 2009 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-21 Duct Leakage Test — Existing Duct System (Page 1 of 2) Site Address: 78-635 Bottlebrush Dr., La Quinta CA 92253 (System Enforcement Agency: Permit Number: 1) City of La Quinta 12-127 Enter the Duct System Name or Identification/Tag: System 1 Enter the Duct System Location or Area Served: Whole House Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the dwelling. This installation certificate is required for compliance for alterations and additions in existing dwellings to space conditioning systems and duct systems. Note: For existing dwellings, a completely new or replacement duct system can also include existing parts of the original duct system (e.g., register boots, air handler, coil, plenums, etc.) if those parts are accessible and they can be sealed. For a completely new or replacement duct system installed in an existing dwelling, use the Installation Certificate titled "Duct Leakage Test - Completely New or Replacement Duct System. " Duct Leakage Diagnostic Test - existing duct system Select one compliance method from the following four choices. 0 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 0 4. Fix all accessible leaks using smoke and HERS rater verify Note: (One of Options_l, 2, or 3 must be attempted,before,utilizing Option.4.)4 Determine nominal Fan Flow using one of.the following three calculation methods. rf" ([ I ✓ 0 Cooling system methh izeo f condenser in Tons 4 x 400 =t� 1600 CFM Jf l ✓ E3Hea;ting a system /method: 21.7 x Output Capacity in Thousands of Btu/hr = _ CFM V Measured, system airflow us `g R 3.3 airflow est procedures: CFM, ,, .�+ ` � .� j��/�' Option i used then: - 1 Allowed leakage = Fan Flow 1600 x 0.15 = 240 CFM Actual Leakage = 233 CFM Pass if Leakage Actual is less than Allowed 13 Pass 0 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 > 600/a 0 Pass ❑ 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 p Pass p Fail CCt.iCx Reg: 212-A0007827A-M2100001A-M21A Registration Date/Time: 2012/02/21 15:26:41 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-21 Duct Leakage Test — Existing Duct System (Page 2 of 2) Site Address: 78-635 Bottlebrush Dr., La Quinta CA 92253 (System Enforcement Agency: Permit Number: 1) City of La Quinta 12-127 0 Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off during duct leakage testing. CFI OA ducts that utilize controlled motorized dampers, that open only when OA ventilation is required to meet ASHRAE Standard 62.2, and close when OA ventilation is not required, may be configured to the closed position during duct leakage testing. 0 All supply/and return register poots must be, sealed to the drywall if. smoke test is utilized for compliance — applies'to duct leakage compliance option 3 (leakage reduction by 60%) and option 4�(fix all'accessible leaks) r escribed abo7j � /i/ 0 � - r ;1( � 1 ``` 01 fJ I, 0 New duct installations,cannot utilize building c,avlties asfplenums�or platform returns in lieu of ducts. R 0 Mastic and draw bands must be used in combination with cloth backed rubber "adhesive duct tape to seal leaks at all new duct connections DECLARATION STATEMENT. • I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct. • I am 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 -6R), signed and submitted by the person(s) responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -111) approved by the enforcement agency. Builder or Installer information as shown on the Installation Certificate (CF -6111) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) AIR EXPERTS AIR CONDITIONING -HEATING Responsible Person's Name: CSLB License: Paul Van Vlymen 725283 HERS Provider Data Registry Information Sample Group * (if applicable): N/A 0 tested/verified dwelling ❑ not-tested/verified dwelling in la HERS sample group HERS Rater Information CaICERTS Certificate # CCI -1798629867 HERS Rater Company Name: Air Solutions of the Desert Responsible Rater's Name: Responsible Rater's Signature: Walter W Nellis Walter W Nellis Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 2/14/2012 CC2004361 Reg: 212-A0007827A-M2100001A-M21A Registration Date/Time: 2012/02/21 15:26:41 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 5) Site Address: Enforcement Agency: Permit Number: 78-635 Bottlebrush Dr., La Quinta CA 92253 1 City of La Quinta 12-127 Note: If installation of a Charge Indicator Display (CID) is utilized as an alternative to refrigerant charge verification for compliance, a MECH-24 Certificate (instead of this MECH-25 Certificate) should be used to demonstrate compliance with the refrigerant charge verification requirement. TMAH and STMS are not required for compliance, when a CID is utilized for compliance. As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an additional form(s) for any additional systems in the dwelling as applicable. Temperature Measurement Access Holes (TMAH) and Saturation Temperature Measurement Sensors (STMS) Procedures for installing TMAH are specified in Reference Residential Appendix RA3.2. If refrigerant charge verification is required for compliance, TMAH are also required for compliance. STMS are only required for completely new or replacement space -conditioning systems that utilize prescriptive compliance method. TMAH - Access Holes in Supply and Return Plenums of Air Handler System Name or Identification/Tag System 1 System Location or Area Served Whole House 1 ® Yes ❑ No 5/16 inch (8 mm) access hole upstream of evaporative coil in the return plenum and labeled according to Figure in Section RA3.2.2.2.2. 2 0 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 ✓ 0 Pass ✓ ❑ Fail STMS - Sensor.on,the Evaporator Coil _.mr System Name or Identification/Tag') /f System 1 The sensor is factory installed, orifield installed according to manufacturer's 3 ❑ Yes /❑ No specifications, or is installed by methods/specifications approved by the Executive " l I/ I f Director. I V 11 / r" !i 'r 4 L /1 ElYes I �J ; }/ i ❑ 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 th61nstalling teEhnician 7 ❑ Yes ❑ No 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 8 ❑ Yes ❑ No saturation temperature of the coil. Yes to 3, 4, and 5 is a pass. Enter N/A if STMS are not ✓ m N/A ✓ ❑ Pass ✓ ❑ Fail applicable. Otherwise enter Pass or Fail ✓ 0 N/A ✓ ❑Pass ✓ ❑Fail STMS - Sensor on the Condenser Coil System Name or Identification/Tag System 1 The sensor is factory installed, or field installed according to manufacturer's 6 ❑ Yes ❑ No specifications, or is installed by methods/specifications approved by the Executive Director. The sensor wire is terminated with a standard mini plug suitable for connection to a 7 ❑ Yes ❑ No digital thermometer. The sensor mini plug is accessible to the installing technician and the HERS rater without changing the airflow through the condenser coil 8 ❑ Yes ❑ No 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 ✓ 0 N/A ✓ ❑Pass ✓ ❑Fail applicable. Otherwise enter Pass or Fail !7 N Reg: 212-A0007827A-M2500001A-M25A Registration Date/Time: 2012/02/21 15:29:09 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-25 Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 5) Site Address: Enforcement Agency: Permit Number: 78-635 Bottlebrush Dr., La Quinta CA 92253 1 City of La Quinta 12-127 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 Svstems System Name or Identification/Tag System 1 (must be re -calibrated monthly) of Thermocouple T Y 2 6/2012J System Location or Area Served Whole House Outdoor Unit Serial # CSD120104408 ---�: .- Outdoor Unit Make Maytag Outdoor Unit Model CSH4BF048KA Nominal Cooling Capacity Btu/hr 48000 Date of Verification 2/14/12 1:aiioravon OT ulagnosric instruments Date of Refrigerant Gauge Calibration 2/6/2012 (must be re -calibrated monthly) of Thermocouple T Y 2 6/2012J (must bev rjt csalibryatred monthly) r� measures i emperatures t: r j r f , r I r ` s r %, " a System Name or Identification/Tag System 1 .r'i r �rrr xr ,., Ji _ Supply (evaporator leaving)'air dry-bulb- 61 — ---�: .- temperature (Tsupply, db) t Return (evaporator entering) air dry-bulb 70 temperature (Treturn, db) Return (evaporator entering) air wet -bulb 56 temperature (Treturn, wb) Evaporator saturation temperature 41 (Tevaporator, sat) Condensor saturation temperature 82 (Tcondensor, sat) Suction line temperature (Tsuction) 61 Liquid Line Temperature (Tliquid) 74 Condenser (entering) air dry-bulb 70 temperature (Tcondenser, db) ? Q Reg: 212-A0007827A-M2500001A-M25A Registration Date/Time: 2012/02/21 15:29:09 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-4R-MECH-251 Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 5)' Site Address: Enforcement Agency: Permit Number: 78-635 Bottlebrush Dr., La Quinta CA 92253 City of La Quinta 12-127 Minimum Airflow Requirement Temperature Split Method Calculations for determining Minimum Airflow Requirement for Refrigerant Charge Verification. The temperature split method is specified in Reference Residential Appendix RA3.2. System Name or Identification/Tag System 1 Calculate: Actual Temperature Split = Treturn, 19.00 db - Tsupply, db Target Temperature Split from Table RA3.2-3 20 using Treturn, wb and Treturn, db Calculate difference: Actual Temperature Split - -1 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 (dm/ton) System Name m r Identification/Tag� r I N r U L f ow Calculated Minimum AirflRequiPrement (CFM) / ! \ ,/•� !I / t 1 J Measured'Airflow;using RA3.3.T! procedurT/es (CFM)![ pfd _Y fI J 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 0 Reg: 212-A0007827A-M2500001A-M25A Registration Date/Time: 2012/02/21 15:29:09 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010 INSTALLATION CERTIFICATE CF-4R-MECH-2E Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 5] Site Address: Enforcement Agency: Permit Number: 78-635 Bottlebrush Dr., La Quinta CA 92253 1 City of La Quinta 12-127 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 = 8.0 Tcondenser, sat - Tliquid Target Subcooling specified by manufacturer 8 Calculate difference: 0 Actual Subcooling - Target Subcooling = System passes if difference is between -4°F and +4°F PASS + ♦ �� I �1 r Enter Pass or Fail V PASS J 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 = 20.0 Tsuction - Tevaporator, sat Enter allowable superheat range from manufacturer's specifications (or use range 20 between 3°F and 26°F if manufacturer's specification is not available) System passes,if actual superheat is within^the 1:' ; ," + ♦ �� I �1 r allowable superheat range % V PASS J V .Enter Pass or Fail j _4 I V/ I � - L; / � - - I \ 11 --j - - , r - \1 . -� 1---) " Ili—, �) b Reg: 212-A0007827A-M2500001A-M25A Registration Date/Time: 2012/02/21 15:29:09 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: 78-635 Bottlebrush Dr., La Quinta CA 92253 City of La Quinta 12-127 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 1725283 HERS Provider Data Registry Information Sample Group # (if applicable): N/A System meets all refrigerant charge and airflow not-tested/verified dwelling in TRERS sample group requirements. PASS Air Solutions of the Desert Responsible Rater's Name: Responsible Rater's Signature: Enter Pass or Fail Walter W Nellis Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 2/14/2012 CC2004361 ck 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 -6R) Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) AIR EXPERTS AIR CONDITIONING -HEATING Responsible Person's Name: CSLB License: Paul Van Vlymen 1725283 HERS Provider Data Registry Information Sample Group # (if applicable): N/A © tested/verified dwelling not-tested/verified dwelling in TRERS sample group HERS Rater Information CalCERTS Certificate * CCI -1798629867 HERS Rater Company Name: Air Solutions of the Desert Responsible Rater's Name: Responsible Rater's Signature: Walter W Nellis Walter W Nellis Responsible Rater's Certification Number w/ this HERS Provider: Date Signed: 2/14/2012 CC2004361 Reg: 212-A0007827A-M2500001A-M25A Registration Date/Time: 2012/02/21 15:29:09 HERS Provider: CalCERTS, Inc. 2008 Residential Compliance Forms March 2010