13-0829 (MECH)• "O. BOX 1504 VOICE (760) 777-7012
4 78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 7/03/13
a�. Application Number: 13-00000829 Owner:
Property Address: 79355 CAMINO ROSADA BOLLARD GARY W
?, APN: 604-191-015-69 -24517 - 79355 CAMINO ROSADO
+ire Application description: MECHANICAL LA QUINTA, CA 92253 lrL�
Property Zoning: LOW DENSITY RESIDENTIAL (
Application valuation: 18278 JUL 03 2013
Contractor:
Applicant: Architect or Engineer: GENERAL AIR CONDITION NG CITY OF LA QUINTA
31170 RESERVE DRIVE FINANCE DEBT
THOUSAND PALMS, CA 92276
(760)343-7488
Lic. No.: 686310
-------------------------------------------------------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with 1 hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: C20 License No.: 686310 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
�'' �_ issued.
Date: -7 3 i3 Contractor: �.n.�.,sL 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
OWNER -BUILDER DECLARATION insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier ZENITH INS CO Policy Number Z071741502
following reason (Sec. 7031,5, Business and Professions Code: Any city or county that requires a permit to _ I certify that, in the performance of the work for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to become subject to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I should become subject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of the Labor Code, I shall forthwith comply with those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: Date: Applicant:
(_ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and T�—
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 _ 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.). i
Lender's Name: _
Lender's Address:
LQPERMIT
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-mentioned property for inspection purposes.
Date: 3 13 Signature (Applicant or Agent): `� ,
e
'LQPERMIT
Application Number 13-00000829
Permit . . . MECHANICAL 2013
Additional desc . .
Permit Fee . . . . 143.00 Plan Check Fee
.00
Issue Date . . . . Valuation . . .
. 0
Expiration Date . . 12/30/13
�r
Qty Unit Charge Per
Extension
`1.
2.00 35.7500 EA MECH FURNACE
71.50
2.00 35.7500 EA MECH CONDENSER/COMP
71.50
----------------------------------------------------------------------------
Special Notes and Comments
HVAC CHANGE OUT REPLACE 3.5 TON A/C 110
K BTU FURNACE 1 DUCT 2 SYSTEMS 2008
ENERGY CODES CARBON MONOXIDE ALARM(S) TO
BE INSTALLED PRIOR TO FINAL INSPECTION
2010 BUILDING CODES.
----------------------------------------------------------------------------
Other Fees . . . . BLDG STDS ADMIN (SB1473)
1.00
PERMIT ISSUANCE M/P/E
90.57
PLAN CHECK, MECHANICAL
47.66
Fee summary Charged Paid Credited
Due
---------------------------------------------------------
Permit Fee.Total 143.00 .00 .00
143.,00
Plan Check Total .00 .00 .00
.00
Other Fee Total 139.23 .00 .00
139.23
Grand Total '282.23 ..00 .00
282.23
e
'LQPERMIT
Bin #
City Of La Quinta
Building &r 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: -?Q3ss cc-mIno �O-so ab
Owner's Name:
A. P. Number:
Address: Cc-rn Dnp �O Sc�c�C7
Legal Description:
City, ST, Zip: L� vi CA et ZZ S3
Contractor: Aira�ki0
Telephone:
Address: 3 \�-7O a5ex vG
Project Description:
City, ST, Zip: Ov6G. cams ZZ7to
lace 3. S tw,% AL 1 101-
-Telephone:
Telephone: -7(,,p_3�1 3_-74 gg
v—r ole sNe
State Lic. # : (06(o 31 C)City
Lic. #;
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone: <<>
Construction Type: Occupancy:
Project ty e (circle one): New Add'n Alter Repair Demo
J P
State Lic. #: :>rF•>:
Name of Contact Person:
Sq. Ft.:
# Stories:#
Units:
Telephone # of Contact Person:
Estimated Value of Project: 1�, 27 8 • CO
APPLICANT: DO NOT WRITE BELOW THIS LINE
q
Submittal
Req'd
Rcc'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance.
Title 24 Cales.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°" Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'"' Review, ready for correctionsfissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
#1
Simplified Prescriptive Certificate of Compliance: 2008 Residential WAICA/terations CF-lR-ALT-HVAC
Climate Zones 10 - 15
Site Address:
Enforcement Agency:
Date:
Permit #:
79355 CAMINO ROSADO La Quinta, CA 92253
City of La Quinta
Jul 2, 2013
Duct insulation
Conditioned Floor
Equipment Type1
List Minimum Efficiency2
requirement
Area
Thermostat
0 Package Unit
® Furnace
® AFUE 78%
Q COP
0 R 6 (CZ 10-13)
Served by system
® Setback
® Indoor Coil
® SEER 15.0
O HSPF
O R 8 (CZ 14 -ZS)
2456
If not already present, must be
® Condensing Unit
p EER
p Resistance
installed)
13 Other
1. Equipment Type: Choose the equipment being installed; if more than one system, use another CF -IR -ALT -HVAC for each system.
2. Minimum Equipment Efficiencies: 13 SEER, 78% AFUE, 7.7HSPF for typical residential systems.
HERS VERIFICATION SUMMARY Usted 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 -6R shall also be on site for final inspection.
® 1. HVAC Changeout
Required Forms:
. All HVAC Equipment
CF -611 forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
replaced
CF -4R forms: MECH-21 and (for split systems) MECH-25
. Condenser Coil and /or
. Indoor Coil and /or
CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS
. Furnace
CF -411 forms: MECH-21 and (for split systems) MECH-25
For Split Systems: Duct leakage:':` -45 percent; RC, CCA <_ 300 CFM/ton (Minimum Air Flow Requirement), TMAH
Exempted from duct leakage testirfg if::
Q l-buct system:vaas documented to have been previously sealed and confirmed through HERS verification, or
.-
13 2: Duct systems with less thA` 0 linear feet in unconditioned space, or
'0:3. Existing dud systems are:tonstructed, insulated or sealed with asbestos
❑ 4: Th! will not be Dined. (ie IDuctlessrri�Spltt ystert AIsQ Exemp� from Ref rger�ai�i G arge)
�systerry
❑ 2. Ne .ti4/AC Sy em
Req uwt
. Cut to oCl►angeout with
-;'
new :(all new�.;::::...::::.s
`rte: ERS '
CF�6tforms MECH-04, MECHfl HERS�ardfor split syes}.MEC >2rti , aid; ';:::::.:.
,: �� > _
l
dudingall neMECH-
r.
0' an�i3;fnrs its'ns' 1CH2Z�ani3=Nil rfi 25 :';
For S it stems :Dpc-t leaf
age 6 percent, R£; CCA z 35t1 Gam#/tan, FWt3 TMAH, 57N1s, and ettCier tISPP o PSPP. `'
For Packaged`tfnitsi Duct
leakage:
[3-3:;Ncw D.ucts.avith/orwithotW` -- -
Required Forms:
RepFdCelle ltri:;'`i:?i:'<'r<e.: ::. :._`
. Includes "replacing or installing.61I Oew
ducting and/or outdoor conden3i�:gunit
CF -6R forms: MECH-04, MECH-20-HERS, and (for split systems) MECH-25-HERS
and/or indoor coil and/or itnaCe_ No .or some
CF -4R forms: MECH-20 and (for split systems) MECH-25
equipment changed.
For Split Systems: Dud leakage < 6 percent; RC, CCA >_ 300 CFM/ton, TMAH
For Packaged Units: Duct leakage < 6 percent
O 4. New Ducting over 40 feet
Required Forms:
. Includes adding or replacing more than 40
CF -6R forms: MECH-04, MECH-2I-HERS
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: Danielle Garcia Signature: Danielle Garcia
Company: HARRISON ENTERPRISES INC Date: Jul 2, 2013
Address:' 31-170 RESERVE DRIVE STE A } Ucense: 686310
City/State/Zip: THOUSAND PALMS / CA / 92276 }: i :, , Phone: (760) 343-7488
Reg: 213-A0049047A-000000000-0000 Registration Date/Time: 2013/07/02'21:52:13 - HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms July 2010
A
INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS
Duct Leakage Test — Existing Duct System (Page 1 of 2)
Site Address:
79355 CAMINO ROSADO, La Quinta CA 92253 (System
Enforcement Agency:
Permit Number:
1)
City of La Quinta
13-829
Enter the Duct System Name or Identification/Tag: System #1 3.ST
Enter the Duct System Location or Area Served: /Q
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 - existinq duct system
Select one compliance method from the following four choices.
M 1. Measured leakage less than 15% of fan flow
❑ 2. Measured leakage to outside less than 10% of Fan Flow
f
❑ 3. Reduce leakage by 60% and conduct smoke and fix all leaks
a
❑ 4..Fix all accessible leaks using smoke and HERS rater verify
i
Note: (One of Options 1, 2 or 3 must be attempted,before utilizing,Option_4,)_ ,;,,_ -
Determine nominal Fan Flow using one of the'following three calculation methods.
'= F'CFM'
✓ ® Cooling system method: Size ofdcondenser in Tons 3.5 x 400 1400
✓ 'C `
❑ Hea#ting system method. 21J x - Output Capacity in Thousands of. Bt-'
= CFMell
procedures:_
✓ ❑ Mea�sured•syste�i airflow using RA3.3 airflow test CFM,
Option 1 used then:
'
1
Allowed leakage = Fan Airflow)
1400 x 0.15 = 210 CFM
Actual Leakage= 46 CFM I
w -
l Pass if Actual Leakage is less than Allowed leakage
® Pass ❑ Fail
Option 2 used then:., i
2
Allowed leakage = Fan Airflow _ x 0.10 = _ CFM
Actual Leakage to outside = I CFM
Pass if Actual leakage to outside is less than Allowed leakage
13 Pass Q 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 1 x 100% _ % Reduction
Pass if % Reduction >= 60%
Pass Fail
Option 4 used then:
4
All accessible leaks repaired using smoke test. HERS rater must verify (No Sampling).
Pass if all accessible leaks have been repaired using smoke
Pass El Fail
Reg: 213-A0049047A-M2100001A-0000 Registration Date/Time: 2013/07/20 19:26:17 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS
Duct Leakage Test — Existing Duct System (Page 2 of 2)
Site Address:
79355 CAMINO ROSADO, La Quinta CA 92253 (System
Enforcement Agency:
Permit Number:
1)
City of La Quinta
13-829
It 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.
IN All supply;an�d,reettu�rn register`boots-must�beosealed to the drywall if smoke test is utilized Mor,
— appliesko duct leakage compliance option 3 (leakage reduction by 60%) and option 41(fix all1accessible
leaks) described above., "." �(
® New duct install.ations..Yccannot utilizebuildingcavities asJpl mums,or`platform returnsAn lieu of dd crts'
L, i F _.�w`
® Mastic and draw bands must.be used in combination with cloth backed rubber adhesive duct tape to seal
leaks at all new duct connections
DECLARATION STATEMENT
• I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct.
• I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized
representative of the person responsible for construction (responsible person).
• I certify that the installed features, materials, components, or manufactured devices identified on this certificate (the installation)
conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the
enforcement agency.
. I understand that a HERS rater will check the installation to verify compliance, and that that if such checking identifies defects, I am
required to take corrective action at my expense. I understand that Energy Commission and HERS provider representatives will also
perform quality assurance checking of installations, including those approved as part of a sample group but not checked by a HERS
rater, and if those installations fail to meet the requirements of such quality assurance checking, the required corrective action and
additional checking/testing of other installations in that HERS sample group will be performed at my expense.
• I reviewed a copy of the Certificate of Compliance (CF -1R) form approved by the enforcement agency that identifies the specific
requirements for the installation. I certify that the requirements detailed on the CF -1R that apply to the installation have been met.
• I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the
building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I
understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder
provides to the building owner at occupancy. I will ensure that all Installation Certificates will come from a HERS provider data
registry for multiple orientation alternatives, and beginning October 1, 2010, for all low-rise residential buildings.
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
HARRISON ENTERPRISES INC dba GENERAL AIR CONDITIONING
Responsible Person's Name:
Responsible Person's Signature:
Danielle Garcia
Danielle Garcia
CSLB License:
Date Signed:
Position With Company (Title):
686310
7/3/2013
Is this installation monitored by a Third Party Quality
Name of TPQCP (if applicable):
Control Program (TPQCP)? ❑ Yes ❑ No
Reg: 213-A0049047A-M2100001A-0000 Registration Date/Time: 2013/07/20 19:26:17 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS
Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 6)
Site Address: Enforcement Agency: Permit Number:
79355 CAMINO ROSADO, La Quinta CA 92253 1 City of La Quinta 13-829
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, unless the TMAH Compliance
Option is chosen.
STMS are only required for completely new or replacement space -conditioning systems that utilize
prescriptive compliance method.
TMAH - Access Holes in SUDDIV and Return Plenums of Air Handier
System Name or Identification/Tag
System #1
3.5T
System Location or Area Served
-K tehen
5/16 inch '(8 mm) access hole
1
upstream of evaporative coil in the
® Yes
❑ Yes
❑ Yes
❑ Yes
return ple�num4and labeled according
to Figure in Section RA3.2 �2'2.2�
, ❑.No
- 0 No
❑_N,o
`},'`
❑ No
.7
.
1a
Ret rn side of the du ctsystemlis
located entirely within cor)rditioned
❑Yes'
OrYes
❑ YeS `t
'
Y O Yes_
space and retugn.1aiMrflow temperature
�
[3No*
j0No
❑.No
- ❑ No^�
to Ike measured at;the return rille.
5/16`inch*(9mm) LLaccess holey'
2
downstream of evaporativei coil in the
® Yes
❑ Yes
❑ Yes
❑ Yes
supply plenum and labeled according
❑ No
❑ No
❑ No
❑ No
to Figure in Section RA3.2.2.2.2.
The TMAH Compliance Option should be checked only if it is physically impossible to drill the TMAH as
required by Section RA3.2.2.2.2. Using this Compliance Option requires the HVAC installer to annotate on
the HERS Providers data registry an explanation as to why the TMAH cannot be installed on the system,
and photographs of the equipment on which the TMAH cannot be installed. Use of this Compliance Option
also requires minimum airflow verification through the direct measurement of airflow per RA3.3
For more information see httpt//www.enerciv.ca.aov/totle24/2008standards/special case appliance/
TMAH Compliance Option ❑
❑
❑
❑
Yes to 1 and 2, or Yes to I and 2, or
checking the TMAH Compliance Option, is ® Pass
❑ Pass
❑ Pass
❑ Pass
a pass. ❑ Fail
❑ Fail
❑ Fail
❑ Fail
Enter Pass or Fail
Reg: 213-A0049047A-M2500001A-0000 Registration Date/Time: 2013/07/20 19:28:58 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2013
:NSTALLATION CERTIFICATE CF-6R-MECH-25-HER;
tefrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 6'
Site Address: Enforcement Agency: Permit Number:
79355 CAMINO ROSADO, La Quinta CA 92253 1 City of La Quinta 13-829
STMS - Sensor on the Evaporator Coil
System Name or
Identification/Tag
System #1 3.5T
�'"
-T
31bhe
sensor is factory installed, or field installed according to manufacturer's specifications, or is installed
y methods/specifications approved by the Executive Director.
❑ Yes ❑ No 1 ❑ Yes ❑ No ❑ Yes ❑ No T ❑ Yes ❑ No
The sensor wire is terminated with a standard mini plug suitable for connection to a digital thermometer.
4
The sensor mini plug is accessible to the installing technician and the HERS rater without changing the
airflow through the condenser coil
❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No
5 IThe sensor measures the saturation temperature of the coil within 1.3 degrees F
`
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Yes to 3, 4, and 5isa
pass.
Enter N/A if STMS are not
® N/A
❑ N/A
❑ N/A
❑ N/A
applicable.
❑ Pass
❑ Pass
❑ Pass
❑ Pass
Otherwise enter Pass or
❑ Fail
❑ Fail
❑ Fail
❑ Fail
Fail
STMS - Sensor on the Condenser Coil
System Name or
Identification%i"ag yr
System #1,3.5T
,: ..f.�
�'"
�`"• ,; :r" x
6
ing toanufacturer' specifications, or is installed
The sensor is factory installed, or4eld installed atcordym
by methods/specific tior% approved=by the Executive,Director.r. .. ..
°` ❑Yes= ❑ No ❑Yes;`❑ No 5,,❑yYes ❑:No .�
The `sensor WIDE s•tter�inrnatedvwith:�a staannd`ard rhipni plug::suitable,for'connection to,a.digiUil the mometee."
7
The sensorwriq plug is accessible,tb theninStallrng�technician`•and the FtERS rater without�che,rr�i- the
airflow through the condenser coil
❑ Yes ❑ No ❑ Yes ❑ No []Yes ❑ No ❑ Yes ❑ No
8 IThe sensor measures the saturation temperature of the coil within 1.3 degrees F
`
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Yes to 6, 7, and 8isa
pass.
Enter N/A if STMS are not
❑ N/A
❑ N/A
❑ N/A
❑ N/A
applicable.
❑ Pass
❑ Pass
❑ Pass
❑ Pass
Otherwise enter Pass or
❑ Fail
❑ Fail
❑ Fail
❑ Fail
Fail
Reg: 213-A0049047A-M2500001A-0000 Registration Date/Time: 2013/07/20 19:28:58 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2013
INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS
Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 6)
Site Address: Enforcement Agency: Permit Number:
79355 CAMINO ROSADO, La Quinta CA 92253 1 City of La Quinta 13-829
Standard Charge Measurement Procedure (for use if outdoor air dry-bulb temperature is 55°F or
above)
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 temperature is less than 55°F, the installer must use the RA3.2.3 Alternate Charge Measurement
Procedure (Weigh -In Charging Method). If the Weigh -In Method is used, the dwelling cannot be included in a sample
group for HERS verification compliance.)
Soace Conditionina Svstems
System Name or Identification/Tag
System #1 3.5T
System Location or Area Served
Kitchen
7/1/2013
(must be re -calibrated
monthly)
Outdoor Unit Serial #
1319E48323
Outdoor Unit Make
LENNOX
Outdoor Unit Model
14ACX-041-230-03
Nominal Cooling,Capacity
3.5 Tons
[Date of Verificationt f
718/j2013 �j
,
-
Calibration of Diagnostic Instruments .�
Date of Refrigerant'Gauge Calibration"7x/1/2013
System #13.5T
monthly')
Date of Thermocouple Calibration
- F
7/1/2013
(must be re -calibrated
monthly)
Measured Temperatures (°F)
mrust�be�'re-caii6raEe°d�`� �
System Name or Identification/Tag
System #13.5T
Supply (evaporator leaving) air dry-bulb
58
temperature (Tsu I db)
48
Return (evaporator entering) air
77
dry-bulb temperature (Treturn db)
109
Return (evaporator entering) air
66
wet -bulb temperature (Treturn wb)
Evaporator saturation temperature
48
(Teva orator sat)
Condensor saturat'on temperature
109
(Tcondensor, sat)
Suction line temperature (Tsuction)
62
Liquid Line Temperature (Tliquid)
100
Condenser (entering) air dry-bulb
97
temperature (Tcondenser, db)
Reg: 213-A0049047A-M2500001A-0000 Registration Date/Time: 2013/07/20 19:28:58 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2013
INSTALLATION CERTIFICATE CF-6R-MECH-25-HER!
tefrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 6;
Site Address: TIERorcement Agency: Permit Number:
79355 CAMINO ROSADO, La Quinta CA 92253 1 City of La Quinta 13-829
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 3.5T
Calculate: Actual Temperature Split =
19.00
Treturn db - Tsupply, db
Target Temperature Split from Table RA3.2-3
17
using Treturn wb and Treturn db
Calculate difference: Actual Temperature
2
Split - Target Temperature Split =
Passes if difference is between -3°F and
+3°F or, upon remeasurement, if between
PASS
-3°F and -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.
X300
Calculated Minimum Airflow Requifementi(CFM) =Nominal Cooling Capacity;(tan)
(gym/ n)
�
S stemamIdentifcation)Tag.,�
System,#13.5T
G
Calculated Minimum Airflow Requirement
(CFM)
Measured Airflow using RA3.3 procedures
(CFM)
Measurement Method
Passes if measured airflow is greater than or
equal to the calculated minimum airflow
requirement.
Enter Pass or Fail
Reg: 213-A0049047A-M2500001A-0000 Registration Date/Time: 2013/07/20 19:28:58 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2013
INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS
Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 6)
Site Address: Enforcement Agency: Permit Number:
79355 CAMINO ROSADO, La Quinta CA 92253 1 City of La Quinta 13-829
Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is
required to be used for fixed orifice metering device systems
System Name or Identification/Tag
System #13.5T
Calculate: Actual Superheat =
9.0
Tsuction - Teva orator sat
Target Superheat from Table RA3.2-2
7
using Treturn wb and Tcondenser, db
14
Calculate difference:
Actual Superheat - Target Superheat =
PASS
._
System passes if difference is between
a
-5°F and +5°F
PASS
Enter Pass or Fail
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 3.5T
Calculate: Actual Subcooling =;
9.0
Tcondenser, sat - Tli uid
Target Subcooling specified by '4
7
manufacturer ,
14
Calculate difference: !
Actual Subcoofing Target Subcooling,=�'s
System p`asses if difference is between'
-3°F and +3°F�
PASS
._
Enter Pass or Fail
a
the allowable superheat range
PASS
Metering,DeVice Calcnlations,for'Refr"igerant Charge Verification.' This procedure'i0required to be
used for thermostatic expansion valve (TXV) and electronic expansion valve (EXV) systems.
System. Name or Identification/Tag
System #1 3.5T
Calculate: Actual Superheat =
14.0
Tsuction - Teva orator sat
Enter allowable superheat range from
manufacturer's specifications (or use range
14
between 4°F and 25°F if manufacturer's
specification is not available)
System passes if actual superheat is within
the allowable superheat range
PASS
Enter Pass or Fail
Reg: 213-A0049047A-M2500001A-0000 Registration Date/Time: 2013/07/20 19:28:58 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2013
INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS
Refrigerant Charge Verification - Standard Measurement Procedure (Page 6 of 6)
Site Address: Enforcement Agency: Permit Number:
79355 CAMINO ROSADO, La Quinta CA 92253 1 City of La Quinta 13-829
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 3.ST
CSLB License:
Date Signed:
17/3/2013
Position With Company (Title):
System meets all refrigerant charge and
Is this installation monitored by a Third Party Quality
Name of TPQCP (if applicable):
airflow requirements.
PASS
Enter Pass or Fail
® Residential Appendix RA3.2.2 requires that if the outdoor temperature is between 55°F and. 65°F the
return air dry bulb temperature shall be maintained above 70°F during the Standard Charge Measurement
Procedure. The signature of the Responsible Person in the declaration statement below certifies this
requirement has been met for all applicable system verifications reported on this certificate.
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 theperson responsible for construction (responsible person).
. I certify that the installed features, materials, components, or manufactured devices identified on this certificate (the
installation) conforms to all applicable codes and regulations, and the installation is consistent with the plans and
specifications approved by the enforcement agency.
. I understand that a HERS rater will check the installation to verify compliance, and that that if such checking identifies
defects, I am required to take corrective action at my expense. I understand that Energy Commission and HERS
provider representatives will also perform quality assurance checking of installations, including those approved as part
of a same eagr p btft not checked by a NIERS i a`tet, and if (hose.installations failato=meet fheBrequiremehts of such
quality assurance checking, the required corrective action and `additional checking/testing of other, installations in that
HERS sample group will be erfo�rmed'at my expense / , I N e --- _ _
. I reviewed,a copy of th�g-ldertificate of Compliance (CF-1R)'fdrm approved by the enforcement agency -that identifies_ the =
specific requirements4pF r the installation. I certify that the requirements detailed -onAhe CF -1R tha&apply-to theme,,
installation have pedWrr�,€t.
a +��; .
. I will egsureithaf a completed, signed .copy,of this Installation Certificate shall be posted,00r mads to dilablei^
with the building'permit(sj issued for the building, and made available to the enforcement agency for all
applicable inspections. I understand that a signed copy of this Installation Certificate is required to be
included with the documentation the builder provides to the building owner at occupancy. I will ensure that
all Installation Certificates will come from a HERS provider data registry for multiple orientation alternatives, and
beginning October 1, 2010, for all low-rise residential buildings.
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
HARRISON ENTERPRISES INC dba GENERAL AIR CONDITIONING
Responsible Person's Name:
Responsible Person's Signature:
Danielle Garcia
Danielle Garcia
CSLB License:
Date Signed:
17/3/2013
Position With Company (Title):
686310
Is this installation monitored by a Third Party Quality
Name of TPQCP (if applicable):
Control Program (TPQCP)? 0 Yes ❑ No
Reg: 213-A0049047A-M2500001A-0000 Registration Date/Time: 2013/07/20 19:28:58 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2013
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-21
Duct Leakage Test — Existing Duct System (Page 1 of 2)
Site Address:
79355 CAMINO ROSADO, La Quinta CA 92253 (System
Enforcement Agency:
Permit Number:
1)
City of La Quinta
13-829
Enter the Duct System Name or Identification/Tag: System #1
Enter the Duct System Location or Area Served: MASTER BDRM
Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the
dwelling.
This installation certificate is required for compliance for alterations and additions in existing dwellings to
space conditioning systems and duct systems.
Note: For existing dwellings, a completely new or replacement duct system can also include existing parts of
the original duct system (e.g., register boots, air handler, coil, plenums, etc.) if those parts are accessible
and they can be sealed. For a completely new or replacement duct system installed in an existing dwelling,
use the Installation Certificate titled "Duct Leakage Test - Completely New or Replacement Duct System. "
Duct Leakage Diagnostic Test - existing duct system
Select one compliance method from the following four choices.
® 1. Measured leakage less than 15% of fan flow
❑ 2. Measured leakage to outside less than 10% of Fan Flow
❑ 3. Reduce leakage by 60% and conduct smoke and fix all leaks
❑ 4 - Fix all accessible leaks using smoke and HERS rater verify
Note: (One of Ooops41, 2, or 3 must be attempted.,before,utilizing 0ption:4.),,,, :
Determinenominal Fan Flow using 'one ofithe following, -three calculation ,method's.#-, J, as t
✓ ® Cooling system method: Size oficondenser in Tons qt 3.5 ;x 400 1400. .CFM,
_
✓ [I Heating system method 21 7 x Output Capacity im Thousands of Btu/hr = CFM
-
J V
T31
❑Measure& _stem airFlow, usin RA3;3 eirf_low-test roce_dures _CFM _ .
Optional used then:; }'
1
Allowed leakage = Fan Flow 1400 x 0.15= 210 CFM
Actual,Leakage =_ CFM; :
3. 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 a 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 reductionCFM
((Leakage reduction _ / Initial leakage x 100% _ /6 Reduction
Pass if % Reduction >= 60%
Pass Ej Fail
Option 4 used then:
4
All accessible leaks repaired using smoke test. HERS rater must verify (No sampling).
Pass if all accessible leaks have been repaired using smoke
Pass Fail
No
.11
Reg: 213-A0049047A-M2100001A-M21A Registration Date/Time: 2013/07/20 20:51:07 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms March 2010
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-21
Duct Leakage Test — Existing Duct System (Page 2 of 2)
Site Address:
79355 CAMINO ROSADO, La Quinta CA 92253 (System
Enforcement Agency:
Permit Number:
1)
City of La Quinta
13-829
�sv
® Outside air (OA)'ducts:for. Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off
during duct leakage.;testing CFI, O:A ducts that utilize controlled motorized dampers, that open only when OA
ventilati'on,is. required..to: meet ASH, RAE Standard 62:2, and close when OA ventilation is not required, may
,be configured to the closed position dunng.duct leakage testing
® All supply and retyurn registeryboots must tie sealed to thud wall if smoke testis utilized fo kcompliance
--appl
leaks)
3
t. q A . ,&guthss3,
® New duet Installatlons-.cannot ubl zebullding cavltles as plenu, sorplatform returns In IleuFofducts j '
® Mastic and draw;tian. ds must,be used, fn corn.bination with{'cloth backed rubberadheslve;duct1f a to seal
leaks at all new duct connections
DECLARATION STATEMENT_ r
I certify under penalty of perjury; untler:•the laws of the State of California, the information provided on this form is true and correct.
rformed the verification services identified and reported on this certificate (responsible rater).
I am the certified HERS rater`ivlo pe
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 -611), signed and submitted by the person(s)
responsible for the installation conforms to the requirements specified on the Certificate(s) of Compliance (CF -1R) approved by the
enforcement aaencv.
Builder or Installer information as shown on the Installation Certificate (CF -6R)
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
HARRISON ENTERPRISES INC
Responsible Person's Name:
CSLB License:
Danielle Garcia
1686310
HERS Provider Data Registry Information
Sample Group # (if applicable): 431295
® tested/verified dwelling
❑ not-tested/verified dwelling in
a HERS sample group
HERS Rater Information CaICERTS Certificate # CC1-1798771877
HERS Rater Company Name:
Stratz Permit Service
Responsible Rater's Name:
Responsible Rater's Signature:
Patrick Schlosser
Patrick Schlosser
Responsible Rater's Certification Number w/ this HERS Provider:
Date Signed: 7/8/2013
CC20OS727
Reg: 213-A0049047A-M2100001A-.M21A Registration Date/Time: 2013/07/20 20:51:07 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 6)
Site Address: Enforcement Agency: Permit Number:
79355 CAMINO ROSADO, La Quinta CA 92253 City of La Quinta 1 13-829
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, unless the TMAH Compliance
Option is chosen.
STMS are only required for completely new or replacement space -conditioning systems that utilize
prescriptive compliance method.
TMAH - Access Holes in SUDDIV and Return Plenums of Air Handler
System Name or Identification/Tag
System #1
System Location or Area Served
MASTER BDRM
5/16 inch..(8 mm) access hole
1
upstream of µevaporative coil in the
'according
®Yes
❑Yes
[3 Yes
13 Yes
return plenum and labeled
❑ No
❑ No
❑ No
❑ No
to Figure,;inxSection RA3.2.2:2:2:
Retufn side of"the duct system is x
la
located entirely within1condi6oned
❑Yes
❑ No`l
C]1Yes.
0 No
❑Yes
❑ No
- ❑Yes
4 ❑,.No.�
space and return (airflow;temperature
toibe measured at,the return grille:
5/f0 inch-.Q31'rfi ri 'access °hole
2
downstream of`evaporative,coil in the_.
® Yes
❑ Yes
❑ Yes
'❑"Yes
supply plenum and labeled, according
❑ No
❑ No
❑ No
❑ No
to Figure in -Section RA3.2:2.2.2.
The TMAH Compliance.,Option should be checked only if the HERS Rater is able to confirm that it was
physically impossible for -the HVAC Installer to drill the TMAH as required by Section RA3.2.2.2.2. Using this
Compliance Option requires the HVAC installer to annotate on the HERS Provider's data registry an
explanation as to why the TMAH cannot be installed on the system, and photographs of the equipment on
which the TMAH cannot be installed. Use of this Compliance Option also requires minimum airflow
verification through the direct measurement of airflow per RA3.3. For more information see
http://www.enerav.ca.goy/totle24/2008standards/special case appliance/
TMAH Compliance Option
❑ ❑
❑
❑
Yes to 1 and 2, or Yes to 1a and 2, or
checking the TMAH Compliance Option, is
® Pass ❑ Pass
❑ Pass
❑ Pass
a pass.
❑ Fail ❑ Fail
❑ Fail
❑ Fail
Enter Pass or Fail
E
Reg: 213-A0049047A-M2500001A-M25A Registration Date/Time: 2013/07/20 20:54:48 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms February 2013
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 6)
Site Address: Enforcement Agency: Permit Number:
79355 CAMINO ROSADO, La Quinta CA 92253 City of La Quinta 1 13-829
STMS - Sensor on the Evaporator Coil
System Name or
System #1
F
I
1
1
Identification/Tag
3
The sensor is factory installed, or field installed according to manufacturer's specifications, or is installed
by methods/specifications approved by the Executive Director.
❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No
The sensor wire is terminated with a standard mini plug suitable for connection to a digital thermometer.
4
The sensor mini plug is accessible to the installing technician and the HERS rater without changing the
airflow through the condenser coil
❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No
5
When attached to a digital thermometer, the sensor provides an indication of the saturation temperature
of the coil.
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Yes to 3, 4, and 5 is a
pass.
Enter N/A if STMS are not
❑ N/A
❑ Pass
pass.
Enter N/A if STMS are not
® N/A
❑ N/A
❑ N/A
❑ N/A
applicable.
❑ Pass
❑ Pass
❑ Pass
❑ Pass
Otherwise enter Pass or
❑ Fail
❑ Fail
❑ Fail
[]Fail
Fail
_ 1
STMS - Sensor on the Condenser Coil
System Name?o
ystem J#
7 " rF11
`
Identifkation/Tag t
61
The sensor is factory iW6talled; or field installedlaccording td manufacturer's specificat?ons, or is installed -
ations`apprpved
by methods/specifa, by the Executive'>Director.'
. _ %j �t� 0 Y,es <❑ N _i _ ❑ Yes ❑`No _ "" Yes ❑ No ❑Yes No
The sehsd-rWels teem inated;with a standard -mini plug?suitable for connection to a -digital W&M, `ometerr'
7
The sensor mini plug is accessible to the installing technician and the HERS rater without changing the
airflow through the condenser coil
- ; ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No
8
When attached to a digital thermometer, the sensor provides an indication of the saturation temperature
'
of the coil.
❑ Yes ❑ No
❑ Yes ❑ No ❑ Yes ❑ No
❑ Yes ❑ No
Yes to 6, 7, and 8 is a
pass.
Enter N/A if STMS are not
❑ N/A
❑ Pass
❑ N/A ❑ N/A
❑ Pass ❑ Pass
❑ N/A
❑ Pass
applicable.
Otherwise enter Pass or
❑ Fail
❑ Fail ❑ Fail
❑ Fail
Fail
Reg: 213-A0049047A-M2500001A-M25A Registration Date/Time: 2013/07/20 20:54:48 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms February 2013
INSTALLATION CERTIFICATE CF-4111-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 6)
Site Address: Enforcement Agency: Permit Number:
79355 CAMINO ROSADO, La Quinta CA 92253 City of La Qui nta 13-829
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 temperature is less than 55°F, the installer must use the RA3.2.3 Alternate Charge Measurement
Procedure (Weigh -In Charging Method). If the Weigh -In Method is used, the dwelling cannot be included in a sample
group for HERS verification compliance.)
Space Conditioning Systems
System Name or Identification/Tag
System #1
System Location or Area Served
MASTER BDRM
7/1/2013
(must be re -calibrated
Outdoor Unit Serial #
1913E48323
Outdoor Unit Make
LENNOX
Outdoor Unit Model
14ACX-041-230-03
Nominal Cooling Capacity
3.5 Tons
Date of Verifications
7/8/2013 ��.
_�
`"ti v
Calibration of Oia0nostic Instr ' ments
Date of Refrigerant Gauge Cal br"ation
,.
7/1/2013.
monthly)
Date of Thermocouple Calibration
7/1/2013
(must be re -calibrated
dry-bulb temperature (Tsu I db)
monthly)
Measured Temperatures.('F)
System Name or Identification/Tag
System #1
Supply (evaporator leaving) air
58
dry-bulb temperature (Tsu I db)
Return (evaporator entering) air
77
dry-bulb temperature (Treturn db)
Return (evaporator entering) air
66
wet -bulb temperature (Treturn wb)
Evaporator saturation temperature
48
(Teva orator sat)
Condensor saturation temperature
109
(Tcondensor, sat)
Suction line temperature (Tsuction)
62
Liquid Line Temperature (Tliquid)
100
Condenser (entering) air dry-bulb
97
temperature (Tcondenser, db)
M
Reg: 213-A0049047A-M2500001A-M25A Registration Date/Time: 2013/07/20 20:54:48 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms February 2013
INSTALLATION CERTIFICATE CF-411-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of 6)
Site Address: Enforcement Agency: Permit Number:
79355 CAMINO ROSADO, La Quinta CA 92253 City of La Quinta 13-829
Minimum Airflow Reauirement
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 =
19.00
Treturn db - Tsupply, db
Target Temperature Split from Table RA3.2-3
17
using Treturn wb and Treturn db
Calculate difference: Actual Temperature
2
Split - Target Temperature Split =
Passes if difference is between -4°F and
+4°F or, upon remeasurement, if between
PASS
-4°F and -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.
• L•
CalculatedMinimumAirfow_ Nominal:Cooling Capacity X 3.00,_
requirement (CFM,) (ton,)
(cfm/ton)
jg�
>
'� .p� •P� i 0 2F
System NameofIdentification/Ta9
y
Calculated Minimum Airflow Requirement
(CFM)
Measured. Airflow using RA3.3 procedures
(CFM)
Measurement Method
Passes if measured airflow is greater than or
equal to the calculated minimum airflow
requirement.
Enter Pass or Fail
Is
Reg: 213-A0049047A-M2500001A-M25A Registration Date/Time: 2013/07/20 20:54:48 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms February 2013
INSTALLATION CERTIFICATE CF-4R-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page S of 6)
Site Address: Enforcement Agency: Permit Number:
79355 CAMINO ROSADO, La Quinta CA 92253 City of La Quinta 1 13-829
Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is
required to be used for fixed orifice metering device systems
System Name or Identification/Tag
System #1
Calculate: Actual Superheat =
14.0
Tsuction - Teva orator sat
9.0
Target Superheat from Table RA3.2-2 using
Treturn wb and Tcondenser, db
7
Calculate difference:
Actual Superheat - Target Superheat =
* ""
` � ,
!
-7
System passes if difference is between -6°F
r
and +6°F
PASS ..'
Enter Pass or Fail
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 Superheat ='
14.0
Calculate: Actual Subcooling ='
9.0
Tcondenser, .sat - Tli uid
Target Subcooling specified by ',;
7
manufacturer
Calculate difference 1 ; , '.� l'
* ""
` � ,
!
-7
Actual Subcooling -Target Subco,oling,=
r
Systempasses if differen�e'is� dbetween
-4°F and +4°F I.: 4
PASS ..'
;Ener Pass or Fail,?
i
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/Ta_g
System #1
Calculate: Actual Superheat ='
14.0
Tsuction - Teva orator sat
Enter allowable superheat range from
manufacturer's specifications (or use range
14
between 3°F and 26°F if manufacturer's
specification is not available)
System passes if actual superheat is within
the allowable superheat range
PASS
Enter Pass or Fail
0
Reg: 213-A0049047A-M2500001A-M25A Registration Date/Time: 2013/07/20 20:54:48 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms February 2013
INSTALLATION CERTIFICATE CF-411-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 6 of 6)
Site Address: Enforcement Agency: Permit Number:
79355 CAMINO ROSADO, La Quinta CA 92253 City of La Qui nta 13-829
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
686310-1
HERS Prov der -Data Registry;;Information
Sample: Group # (if applicable): 431295
System meets all refrigerant charge and
not-tested/verified dwelling
lin
I _
a HERS sample group
airflow requirements.
PASS
Stratz Permit Service
Responsible Rater's Name:
Responsible Rater's Signature:
Enter Pass or Fail
Patrick Schlosser
Responsible Rater's Certification Number w/ this HERS
Date Signed: 7/8/2013
Provider:
® Residential Appendix RA3.2.2 requires that if the outdoor temperature is between 55°F and 65°F the
return air dry bulb temperature shall be maintained above 70°F during the Standard Charge Measurement
Procedure. The signature of the Responsible Person in the declaration statement below certifies this
requirement has been met for all applicable system verifications reported on this certificate.
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. -
y.
. The information reported on applicable sections of the Installation Certificate(s) (CF 6R), signed and submitted by the
person(s)�responsible,.for the ins6liationconforms toithefequirements-specified on the Cert'ficate(s)xof lZompliance
CF -1R a roved:b",the enforcement,ra enc >:
Builderfbr Installer informationa,as`shown'on;Ithe,Installatidh Certificate (CF=6R)
Company Name: (Installing Subcontractor or General Cgntr_actor oe"Builder/Owner).
HARRISON ENT�RPR;SEStI:NC% ;r
ResponsiblekPecs6n's.Name` -..CSLB`:Licepse.
•-kap - ,?
Danielle Garcia¢ ` -:-:
686310-1
HERS Prov der -Data Registry;;Information
Sample: Group # (if applicable): 431295
® tested/verified dwelling0
not-tested/verified dwelling
lin
I _
a HERS sample group
HERS Rater Information, CalCERTS Certificate # CC1-1798771877
HERS Rater Company Name:
Stratz Permit Service
Responsible Rater's Name:
Responsible Rater's Signature:
Patrick Schlosser
Patrick Schlosser
Responsible Rater's Certification Number w/ this HERS
Date Signed: 7/8/2013
Provider:
CC20OS727
1
I�
2
Reg: 213-A0049047A-M2500001A-M25A Registration Date/Time: 2013/07/20 20:54:48 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms February 2013
li
li
i
INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS
butt Leakage Test — Existing Duct System (Page 1 of 2)
Site Address:
79355 CAMINO ROSADO, La Quinta CA 92253 (System
Enforcement Agency:
Permit Number:
1)
City of La Quinta
13-829
Enter the Duct System Name or Identification/Tag: System #2 3.ST
Enter the Duct System Location or Area Served: KITCHEN
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.
IM 1. Measured leakage less than 15% of fan flow
2. Measured leakage to outside less than 10% of Fan Flow
Reduce leakage by conduct leaks
3. 60% and smoke and fix all
1 ,
4. Fix all accessible leaks using smoke and HERS rater verify
Note: (One of Options 1, 2 or 3 must be attempted beforeyutilizing,Option 4.)�
Determine nominal Fan Flow using 'one ofthe'fol lowing: three calculation methods.' fi r • / C
7,t'
u
VO Cooling system method: Size 4,.condenser in Tons J 3.5' x 400 – • 140o` CFM
...
❑ Heating Tusands of Btu/hr CFM
hod ho
system me 21:7 x Output Capacity in = _
_.
❑ Measured CFM
system airflow using'RA3.3 airflow^test procedures:
Option,1 used then:
Allowed leakage = Fan Airflow) 1400 0.15 = 210 CFM
1
x
Actual Leakage° , 197 CFM
Pass if Actual Leakage is less than Allowed leakage
® Pass ❑ Fail
Option 2 used then:-
2
Allowed leakage = Fan Airflow_ x 0.10 = _ CFM
Actual Leakage to outside-= ' CFM
Pass if Actual leakage to outside is less than Allowed leakage
0 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 >= 600/6
13 Pass E3 Fail
Option 4 used then:
4
All accessible leaks repaired using smoke test. HERS rater must verify (No Sampling).
Pass if all accessible leaks have been repaired using smoke
Cl Pass Fail
Reg: 213-A0049048A-M2100001A-0000 Registration Date/Time: 2013/07/20 19:37:57 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS
Duct Leakage Test — Existing Duct System (Page 2 of 2)
Site Address:
79355 CAMINO ROSADO, La Quinta CA 92253 (System
Enforcement Agency:
Permit Number:
1)
City of La Quinta
13-829
® Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off
during duct leakage testing. CFI OA ducts that utilize controlled motorized dampers, that open only when OA
ventilation is required to meet ASHRAE Standard 62.2, and close when OA ventilation is not required, may
be configured to the closed position during duct leakage testing.
® All supply,and return register"bootsrmus be s sled to the drywall if smoke te�lized fo 7Compliance
— appliesrtolduct leakage compliance option 3 '(leakage reduction,by 60%) and option 4$(fix all"accessible
leaks) described above
® New duct installations,.cannot utilize building cavities aslplenumsior platform returns In lieu of ducts vC�
® Mastic and draw bands must be used in.combination.with cloth backed rubber adhesive ductxtape to seal
leaks at all new duct connections
DECLARATION STATEMENT
. I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct.
. I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized
representative of the person responsible for construction (responsible person).
. I certify that the installed features, materials, components, or manufactured devices identified on this certificate (the installation)
conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the
enforcement agency.
. I understand that a HERS rater will check the installation to verify compliance, and that that if such checking identifies defects, I am
required to take corrective action at my expense. I understand that Energy Commission and HERS provider representatives will also
perform quality assurance checking of installations, including those approved as part of a sample group but not checked by a HERS
rater, and if those installations fail to meet the requirements of such quality assurance checking, the required corrective action and
additional checking/testing of other installations in that HERS sample group will be performed at my expense.
. I reviewed a copy of the Certificate of Compliance (CF -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 instaliFtion have been met.
. I will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the
building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I
understand that a signed copy of this Installation Certificate is required to be included with the documentation the builder
provides to the building owner at occupancy. I will ensure that all Installation Certificates will come from a HERS provider data
registry for multiple orientation alternatives, and beginning October 1, 2010, for all low-rise residential buildings.
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
HARRISON ENTERPRISES INC dba GENERAL AIR CONDITIONING
Responsible Person's Name:
Responsible Person's Signature:
Danielle Garcia
Danielle Garcia
CSLB License:
Date Signed:
Position With Company (Title):
686310
7/3/2013
Is this installation monitored by a Third Party Quality
Name of TPQCP (if applicable):
Control Program (TPQCP)? ❑ Yes ❑ No
Reg: 213-A004904BA-M2100001A-0000 Registration Date/Time: 2013/07/20 19:37:57 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms March 2010
INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS
Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 6)
Site Address: Enforcement Agency: Permit Number:
79355 CAMINO ROSADO, La Quinta CA 92253 1 City of La Quinta 13-829
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, unless the TMAH Compliance
Option is chosen.
STMS are only required for completely new or replacement space -conditioning systems that utilize
prescriptive compliance method.
TMAH - Access Holes in Suppiv and Return Plenums of Air Handler
System Name or Identification/Tag
System #2
System Location or Area Served
KITCHEN
5/16 inch (8 mm) access hole
1
upstream of evaporative coil in the
® Yes
❑ Yes
❑ Yes
❑ Yes
return plenum and labeled according
❑ No
❑ No
Cl No
❑ No
to Figure i0, action RA3.2.2.2.2. _-1v*
,
.. f.....
�.�.�.�:
Returff side of the duct system isr e`
la
located entirely withfn/cond'itioned
space and return low temperature
(Q Yes
❑ No
/ OkYes
EYNo
❑ Yes
❑ No�S `-z
❑ Yes_
0 No
p,
:�
to be measured/othe retu"rngrille.
.,..,.
5/lt inch (;8 frfm):access hole
'
c.
downstream o'f,evaporative coilin the
® Yes
❑ Yes
❑ Ye
, ❑;Yes
2
supply plenum and labeled according
❑ No
❑ No
❑ No
❑ No
to Figure.in.Section RA3.2.2.2.2.
The TMAH Compliance Option should be checked only if it is physically impossible to drill the TMAH as
required by Section RA3.2.2.2.2. Using this Compliance Option requires the HVAC installer to annotate on
the HERS Provider's data registry an explanation as to why the TMAH cannot be installed on the system,
and photographs of the equipment on which the TMAH cannot be installed. Use of this Compliance Option
also requires minimum airflow verification through the direct measurement of airflow per RA3.3
For more information see http://www.energy.ca.gov/title24/2008standards/special case appliance/
TMAH Compliance Option
❑ ❑ ❑
❑
Yes to 1 and 2, or Yes to I and 2, or
checking the TMAH Compliance Option, is
® Pass ❑ Pass ❑ Pass
❑ Pass
a pass.
❑ Fail ❑ Fail ❑ Fail
❑ Fail
Enter Pass or Fail
Reg: 213-A0049048A-M2500001A-0000 Registration Date/Time: 2013/07/20 19:40:19 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2013
INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS
Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 6)
Site Address: Enforcement Agency: Permit Number:
79355 CAMINO ROSADO, La Quinta CA 92253 1 City of La Quinta 13-829
STMS - Sensor on the Evanorator Coil
System Name or
System #2
-.� A ..
'' �-� r^=-,
Identification/Tag
The sensor is factory installed, or/field installed according to manufacturer's specifieatiions, or is installed
by methods/specifiga Jons approved by the Executive Director.-
µ ,❑Yes 0 N 11 QYes.❑No f 13 Yes 13 No QYes�❑:N.o�
3
The sensor is factory installed, or field installed according to manufacturer's specifications, or is installed
7
by methods/specifications approved by the Executive Director.
❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No
airflow through the condenser coil
The sensor wire is terminated with a standard mini plug suitable for connection to a digital thermometer.
4
The sensor mini plug is accessible to the installing technician and the HERS rater without changing the
; ❑ Yes []No
airflow through the condenser coil
❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No
5 IThe sensor measures the saturation temperature of the coil within 1.3 degrees F
Yes to 6, 7, and 8 is a
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Yes to 3, 4, and 5 is a
❑ N/A
❑ Pass
❑ N/A
❑ Pass
❑ N/A
❑ Pass
❑ N/A
❑ Pass
pass.
Enter N/A if STMS are not
® N/A
❑ N/A
❑ N/A
❑ N/A
applicable.
❑ Pass
❑ Pass
❑ Pass
❑ Pass
Otherwise enter Pass or
❑ Fail
❑ Fail
❑ Fail
❑ Fail
Fail
STMS - Sensor -on the Condenser Coil
System Name or
Identificatiora/Tag
System #2.
_ �••,•
-.� A ..
'' �-� r^=-,
6
The sensor is factory installed, or/field installed according to manufacturer's specifieatiions, or is installed
by methods/specifiga Jons approved by the Executive Director.-
µ ,❑Yes 0 N 11 QYes.❑No f 13 Yes 13 No QYes�❑:N.o�
The sensor wine is te6minated,with a sta d'ardmini plug,suitable,for connection to a.digital thermometer.'
y. f -,,
7
, x-� .,. r
*'A61
The sensor«rAlug is accessible to•the installing technician and,theaHERS rater without chan°gin,g the.i,
airflow through the condenser coil
_�- ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No
8 The sensor measures the saturation temperature of the coil within 1.3 degrees F
`
; ❑ Yes []No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Yes to 6, 7, and 8 is a
pass.
Enter N/A if STMS are not
❑ N/A
❑ Pass
❑ N/A
❑ Pass
❑ N/A
❑ Pass
❑ N/A
❑ Pass
applicable.
Otherwise enter Pass or
❑ Fail
❑ Fail
❑ Fail
❑ Fail
Fail
Reg: 213-A0049048A-M2500001A-0000 Registration Date/Time: 2013/07/20 19:40:19 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2013
INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS
Refrigerant Charge Verification - Standard Measurement Procedure (Page 3 of 6)
Site Address: Enforcement Agency: Permit Number:
79355 CAMINO ROSADO, La Quinta CA 92253 1 City of La Quinta 13-829
Standard Charge Measurement Procedure (for use if outdoor air dry-bulb temperature is 55°F or
above)
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 temperature is less than 55°F, the installer must use the RA3.2.3 Alternate Charge Measurement
Procedure (Weigh -In Charging Method). If the Weigh -In Method is used, the dwelling cannot be included in a sample
group for HERS verification compliance.)
Space Conditionin4 Systems
System Name or Identification/Tag
System #2
(must:be"re-calibrated�'�
System Location or Area Served
KITCHEN
7/1/2013
(must be re -calibrated
Outdoor Unit Serial #
1913E48324
Outdoor Unit Make
LENNOX
Outdoor Unit Model'
14ACX-041-230-03
Nominal Cooling. Capacity
3.5 Tons
Date of/Verification f '`
`
7%8/j2013
4 s
y
Calibration of Dia nostic instruments rt
�
Date of Refrigerant, Gauge Calibration
771/2013
(must:be"re-calibrated�'�
monthly)
Date of Thermocouple Calibration
7/1/2013
(must be re -calibrated
temperature (Tsu I db)
monthly)
r
Measured Temperatures (°F)
System Name or Identification/Tag
System #2
Supply (evaporator leaving) air dry-bulb
60
temperature (Tsu I db)
56
Return (evaporator entering) air
81
dry-bulb temperature (Treturn db)
120
Return (evaporator entering) air
66
wet -bulb temperature (Treturn wb)
Evaporator saturation temperature
56
(Teva orator sat)
Condensor saturation temperature
120
(Tcondensor, sat)
Suction line temperature (Tsuction)
G8
Liquid Line Temperature (Tliquid)
110
Condenser (entering) air dry-bulb
109
temperature (Tcondenser, db)
7.1
Reg: 213-A0049048A-M2500001A-0000 Registration Date/Time: 2013/07/20 19:40:19 HERS Provider: Ca10ERTS, Inc.
2008 Residential Compliance Forms March 2013
INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS
Refrigerant Charge Verification - Standard Measurement Procedure . (Page 4 of 6)
Site Address: Enforcement Agency: Permit Number:
79355 CAMINO ROSADO, La Quinta CA 92253 1 City of La Quinta 13-829
Minimum Airflow Reauirement
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 #2
Calculate: Actual Temperature Split =
21.00
Treturn db - Tsupply, db
Target Temperature Split from Table RA3.2-3
19
using Treturn wb and Treturn db
Calculate difference: Actual Temperature
2
Split - Target Temperature Split =
Passes if difference is between -3°F and
+3°F or, upon remeasurement, if between
PASS
-3°F and -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 AirflowRequirement (CFM) = Nominal Cooling Capackty"(ton),X 300
(gym/ t6 n)
Systemame or4dentif catidn/Tag\
System #2
,#
Calculated Minimum -Airflow Requirement
(CFM) - i
Measured Airflow using RA3.3 procedures
(CFM)
Measurement Method
Passes if measured airflow is greater than or
equal to the calculated minimum airflow
requirement.
Enter Pass or Fail
�e
P
Reg: 213-A0049048A-M2500001A-0000 Registration Date/Time: 2013/07/20 19:40:19 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2013
t ,
INSTALLATION CERTIFICATE CF-611-MECH-25-HERS
Refrigerant Charge Verification - Standard Measurement Procedure (Page 5 of 6)
Site Address: Enforcement Agency: Permit Number:
79355 CAMINO ROSADO, La Quinta CA 92253 1 City of La Quinta 13-829
Superheat Charge Method Calculations for Refrigerant Charge Verification. This procedure is
required to be used for fixed orifice metering device systems
System Name or Identification/Tag
System #2
Calculate: Actual Superheat =
10.0
Tsuction - Teva orator sat
Target Superheat from Table RA3.2-2
9
using Treturn wb and Tcondenser, db
12
Calculate difference:
:`1"j "1
f
7
Actual Superheat - Target Superheat =
o
System passes if difference is between
'L
-5°F and +5°F
PASS
Enter Pass or Fail
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 #2
Calculate: Actual Subcooling =',
10.0
Tcondenser, sat - Tli uid
Target'Subcooling specified by '
9
manufacturer
12
Calculate difference:
Actual'Sub.c-o'0iing Target Subeooling-,=T"
:`1"j "1
f
7
System passes if differenceis between
-3°F and +3°F . r,PAS
o
of jEnter Pass or Fail
'L
.:,-I/ `f
Metering Device Calculations for'Refrigerant Charge Verification: This procedere i0requ ied to be
used for thermostatic expansion'valve (TXV).and electronic expansion valve (EXV) systems.
System Name o Ir dentification/,Tag
System #2
Calculate: Actual Superheat = '
12.0
Tsuction - Teva orator sat
Enter allowable superheat range from
manufacturer's specifications (or use range
12
between 4°F and 25°F if manufacturer's
specification is not available)
System passes if actual superheat is within
the allowable superheat range
PASS
Enter Pass or Fail
Reg: 213-A0049048A-M2500001A-0000 Registration Date/Time: 2013/07/20 19:40:19 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2013
INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS
Refrigerant Charge Verification - Standard Measurement Procedure (Page 6 of 6)
Site Address: Enforcement Agency: Permit Number:
79355 CAMINO ROSADO, La Quinta CA 92253 1 City of La Quinta 13-829
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 #2
CSLB License:
Date Signed:
17/3/2013
Position With Company (Title):
System meets all refrigerant charge and
Is this installation monitored by a Third Party Quality
Name of TPQCP (if applicable):
airflow requirements.
PASS
Enter Pass or Fail
® Residential Appendix RA3.2.2 requires that if the outdoor temperature is between 55°F and 65°F the
return air dry bulb temperature shall be maintained above 70°F during the Standard Charge Measurement
Procedure. The signature of the Responsible Person in the declaration statement below certifies this
requirement has been met for all applicable system verifications reported on this certificate.
DECLARATION STATEMENT
. I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true
and correct.
. I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an
authorized representative of the person responsible for construction (responsible person).
. I certify that the installed features, materials, components, or manufactured devices identified on this certificate (the
installation) conforms to all applicable codes and regulations, and the installation is consistent with the plans and
specifications approved by the enforcement agency.
. I understand that a'HERS rater will check the installation to verify compliance, and that that if such checking identifies
defects, I am required to take corrective action at my expense. I understand that Energy Commission and HERS
provider representatives will also perform quality assurance checking of installations, including those approved as part
Of a sample-g`roupYodt not checked -by a HENS" rater; and-iif;those.installationsfail to meet fhe requirements of such
quality .assurance checking, the required corrective action and 'addifi "nal checking/testing of_other installations in that
HERS sample group will be perforrmed at my expense.]
. I reviewed a copy of tl�peCUrtificate of Compliance (CF -IR) form approved'b' the enforcement ag ncy.that identifies the
specific requirements4or the installation. I certify that the requirements detailed oripthe CF -1R that apply to the,. -y
installation have een, met. �" 4 d f f r
ab -W,� r + -., a 1 t ! I
. I will ensure,rthat a completed, signed.copy.of;this Installation Certificate shall be posted,+or ma'degavailable
with the building perniit(s)'issued for the building, and made available to the enforcement agency for�all
applicable inspections. I understand that a signed copy of this Installation Certificate is, required to be
included with.the documentation the builder provides to the building owner at occupancy. I will ensure that
all I.nstallation Certificates will come from a HERS provider data registry for multiple orientation alternatives, and
beginning October 1, 2010, for all low-rise residential buildings.
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
HARRISON ENTERPRISES INC dba GENERAL AIR CONDITIONING
Responsible Person's Name:
Responsible Person's Signature:
Danielle Garcia
Danielle Garcia
CSLB License:
Date Signed:
17/3/2013
Position With Company (Title):
686310
Is this installation monitored by a Third Party Quality
Name of TPQCP (if applicable):
Control Program (TPQCP)? 0 Yes 0 No
Reg: 213-A0049048A-M2500001A-0000 Registration Date/Time: 2013/07/20 19:40:19 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2013
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-21
Duct Leakage Test — Existing Duct System (Page 1 of 2)
Site Address:
79355 CAMINO ROSADO, La Quinta CA 92253 (System
Enforcement Agency:
Permit Number:
1)
City of La Quinta
13-829
=nter the Duct System Name or Identification/Tag: System 1
_nter the Duct System Location or Area Served: Whole House
Vote: Submit one Installation Certificate for each duct system that must demonstrate ccmpliance in the
1welling.
This installation certificate is required for compliance for alterations and additions in existing dwellings to
space conditioning systems and duct systems.
Vote: 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,
ise the Installation Certificate titled "Duct Leakage Test - Completely New or Replacement Duct System. "
Duct Leakage Diagnostic Test - existing duct system
Select one compliance method from the following four choices.
❑ 1. Measured leakage less than 15% of fan flow
❑ 2. Measured leakage to outside less than 10% of Fan Flow
❑ 3. Reduce leakage by. 60% and conduct smoke and fix all leaks
❑ 4. Fix all accessible leaks using smoke and HERS rater verify
t.
Note: (One of Qptons 1, 2, or 3 must be attemptedbeforeputilizig Option 4
Determine�,noniinal Fan Flow using one oaf the followjng three calculation methods
✓ ❑ Cooling"system method S ze oficondenser in Tons) x 400 _ CF✓M
_ .
✓ ❑ Heatiri` s stem method 21.72 Output Capacity n.Thousanfds of8tu/hr —
_CFM
�,';
✓ ❑ Measured airflow using. RA3 3 airflow test procedures„--� CFM`
f�
Option,l used then:
1
Allowed leakage = Fan Flow=' x 0:15 = _CFM
Actual,Leakage`'- _ CFM
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 E3 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 reductionCFM
((Leakage reduction _/ Initial leakage _) x 100% _ /b Reduction
Pass if % Reduction
>= 60%
Pass r3 Fail
Option 4 used then:
4
All accessible leaks repaired using smoke test. HERS rater must verify (No sampling).
Pass if all accessible leaks have been repaired using smoke
Pass Fail
r
U
Reg: 213-A00490487,-M2100001A-M21A Registration Date/Time: 2013/07/20 20:51:07 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-21
Duct Leakage Test — Existing Duct System (Page 2 of 2)
Site Address:
79355 CAMINO ROSADO, La Quinta CA 92253 System,
Enforcement Agency:
Permit Number:
1)
City of La Quinta
13-829
❑ Outside air. (OA) duct s1or:Cenf`ra[ Fan Integrated (CFI) ventilation systems, shall not be sealed/taped off
during -duct leakage/testing. CFhQA ducts that utilize controlled motorized dampers, that open only when OA'
ventilation is. required to meet ASRRAE Standard 62.2, and close when OA ventilation is not required, may
`be,configured.to the closed'positign during duct leakage testing.
Yt .t, i . 3�" a E .`�'„� �r'
❑ All sup ly and"return register'bpot _must tiesealedtothe dry�wall;lfsmokewtest,ie utilized for�_compliance
aIles;toduct I -
leaks) desq_n, ed a
❑ New duct"lnst J(atlont.carkno
❑ Mastic arid`draw bands' must
leaks at all new duct connectio
�3
pe to seal
DECLARATION STATEMENT `�;`s ;:
•I certify under penalty of pei)ury, untleahe laws of the State of California, the information provided on this form is true and correct.
• I am the certified HERS rater:Wh.o p&, ormed the verification services identified and reported on this certificate (responsible rater).
• The installed feature, material, cornponent, 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 -SR) 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 aaencv.
Builder or Installer information as shown on the Installation Certificate (CF -6R)
Company Name: (Installing Subcontractor or General Contractoror Builder/Owner)
HARRISON ENTERPRISES INC
Responsible Person's Name:
CSLB License:
Danielle Garcia
1686310
HERS Provider Data Registry Information ;.
Sample Group # (if applicable): 431295
❑ tested/verified dwelling
® not-tested/verified dwelling in
la
HERS sample group
HERS Rater Information CalCERTS Certificate # CCl-1798771878
HERS Rater Company Name:
Stratz Permit Service
Responsible Rater's Name:
Responsible Rater's Signature:
Patrick Schlosser
Patrick Schlosser
Responsible Rater's Certification Number w/ this HERS Provider:
Date Signed: 7/8/2013
CC2005727
Reg: 213-A0049048A-M2100001A=M21A Registration Date/Time: 2013/07/20 20:51:07
2008 Residential Compliance Forms
t
HERS Provider: CalCERTS, Inc.
March 2010
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 16)
Site Address: Enforcement Agency: Permit Number: i
79355 CAMINO ROSADO, La Quinta CA 92253 City of La Quinta 13-829
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 charg
verification is required for compliance, TMAH are also required for compliance, unless the TMAH Compliance
Option is chosen.
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 i
System Location or Area Served
Whole House
j
5/16 inch .(8 mm) access hole
1
upstream of evaporative coil in the
'according
❑ Yes
❑ Yes
❑ Yes
❑ Yes
return plenum and labeled
❑ No
❑ No
❑ No
❑ No
to Figurae,-in-Section RA3.2.2 .2:
Retufn,,,Side ofAhe duct system:i's,
la
located entirely within~conditioned `
aiow teemperature
space and returnrfl
❑ Yes
❑ No
❑ Yesa
El No'
❑ Y s..
13 Not' '
El Yes
❑ No
,
''�.
""
totbe,measurred at the #'urn j'grille.
I
� ��-
5/f6 in (8"mm access hole`+
,�/'.
2
downstream of'evaporative+coiP in the -
:. Yes,, -
❑ Yes
❑Yes : -
❑Yes
supply plenum and labeled according
❑ No
❑ No
❑ No
❑ No
to Figure in Section RA3.2.2.2.2.
The TMAH Compliance Option should be checked only if the HERS Rater is able to confirm that it was
physically impossible for,the HVAC Installer to drill the TMAH as required by Section RA3.2.2.2.2. Using this
Compliance Option requires the HVAC installer to annotate on the HERS Provider's data registry an
explanation as to why the TMAH cannot be installed on the system, and photographs of the equipment on
which the TMAH cannot be installed. Use of this Compliance Option also requires minimum airflow
verification through the direct measurement of airflow per RA3.3. For more information see
http://www.eneray.ca.ciov/title24/`2008standards/spec6al case appliance/
TMAH Compliance Option
❑
❑
❑
❑
i
Yes to 1 and 2, or Yes to la and 2, or
checking the TMAH Compliance Option, is
❑ Pass
❑ Pass
❑ Pass
❑ Pass
a pass.
❑ Fail
❑ Fail
❑ Fail
❑ Fail
Enter Pass or Fail
Reg: 213-A0049048A-M2500001A-M25A Registration Date/Time: 2013/07/20 20:54:48 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms I February 2013
4' ,
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-411-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 2 of 6)
Site Address: Enforcement Agency: Permit Number:
79355 CAMINO ROSADO, La Quinta CA 92253 City of La Quinta 1 13-829
STMS - Sensor or, the Evaporator Coil
System Name or
+
Identification/Tag
The sensor is factory installed, or field installe&according to' manufacturer's specifications, or is stalled
by m:. ethods/specifications. a`Pproved-.by the Executive�Diredor
3
The sensor is factory installed, or field installed according to manufacturer's specifications,. or is installed
by methods/specifications approved by the Executive Director.
❑ Yes ❑ No 1 ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No
The sensor mini plug is accessible to the installing technician and the HERS rater without changing the
The sensor wire is terminated with a standard mini plug suitable for connection to a digital thermometer.
4
The sensor mini plug is accessible to the installing technician and the HERS rater without changing the
8
airflow through the condenser coil
❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No
5
When attached to a digital thermometer, the sensor provides an indication of the saturation temperature
❑ Yes ❑ No
of the coil.
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Yes to 3, 4, and 5 is a
pass.
Enter N/A if STMS are not
❑ N/A
❑ Pass
❑ N/A
❑ Pass
pass.
Enter N/A if STMS are not
❑ N/A
❑ N/A
❑ N/A
❑ N/A
applicable.
❑ Pass
❑ Pass
❑ Pass
❑ Pass
Otherwise enter Pass or.
❑ Fail
❑ Fail
❑ Fail
❑ Fail
Fail
STMS - Sensor on the Condenser Coil
System NameFor
Identificafion/Tag U
+
6
The sensor is factory installed, or field installe&according to' manufacturer's specifications, or is stalled
by m:. ethods/specifications. a`Pproved-.by the Executive�Diredor
YONo `_q°YesYes go N. . ❑ No f .. ; ❑Yes.f13 Nodif
The sensor'wire"is terminatedi with a standard minFplug suitable for connection to' a digital therm'om`eter:-�
7
The sensor mini plug is accessible to the installing technician and the HERS rater without changing the
airflow through=the condenser. coil
❑.Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No
8
When attached to a digital thermometer, the sensor provides an indication of the saturation temperature
of the coil.
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Yes to 6, 7, and 8 is a
pass.
Enter N/A if STMS are not
❑ N/A
❑ Pass
❑ N/A
❑ Pass
❑ N/A
❑ Pass
❑ N/A
❑ Pass
applicable.
Otherwise enter Pass or
❑ Fail
❑ Fail
❑ Fail
❑ Fail
Fail
0
I� Reg: 213-A0049048A-M2500001A-M25A Registration Date/Time: 2013/07/20 20:54:48 HERS Provider: CalCERTS, Inc.
1 2008 Residential Compliance Forms February 2013
f
INSTALLATION CERTIFICATE CF-4R-MECH=25
Refrigerant Charge Verification - Standard Measurement Procedure I(Page 3 of 6)
Site Address: Enforcement Agency: Permit Number:
79355 CAMINO ROSADO, La Quinta CA 92253 City of La Qui nta 13-829
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 temperature is less than 55°F, the installer must use the RA3.2.3 Alternate Charge Measurement
Procedure (Weigh -In Charging Method). If the Weigh -In Method is used, the dwelling cannot be included in a sample
group for HERS verification compliance.)
Space Conditioning Systems
System Name or Identification/Tag
System 1
"�'v,zf•;';;, .
(must. be re calibrated"monthly)
x
System Location or Area Served
Whole House
(must be re -calibrated monthly)
Outdoor Unit Serial #
Outdoor Unit Make -=
Outdoor Unit Model—'
Nominal Cooling Capacity
Date of Verification
y
a&Y.�d?
%y
� �$�M..
`-�.d�s�K���s,.
. '!. '�•t``:..�9'..ze�S
kr
ti ._
xv
Calibration of• Dia nosiic Instruments °{,RV
...9. �.,._ ra.
'r*ri,'."t'`
Date of Refngerant Gauge�Calibrat�on
7�?'f ° ry;"F'"
"�'v,zf•;';;, .
(must. be re calibrated"monthly)
x
Supply (evaporator leaving) air dry-bulb
Date of Thermocouple Calibration.
(must be re -calibrated monthly)
temperature (Tsu I db)
Measured Temoeraturesr('F) =
System Name or Identificatiori%Tag
System 1 .
Supply (evaporator leaving) air dry-bulb
temperature (Tsu I db)
Return (evaporator entering) air
dry -;bulb temperature (Treturn db)
Return (evaporator entering) air
wet -bulb temperature (Treturn wb)
Evaporator saturation temperature
(Teva orator sat)
Condensor saturation temperature
(Tcondensor, sat)
Suction line temperature (Tsuction)
Liquid Line Temperature (Tliquid)
Condenser (entering) air dry-bulb
temperature (Tcondenser, db)
Reg: 213-A0049048A-M2500001A-M25A Registration Date/Time: 2013/07/20 20:54:48 HERS Provider: CalCERT8, Inc.
2008 Residential Compliance Forms February 2013
i
INSTALLATION CERTIFICATE CF-4R-MECH X25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 4 of
6)
Site Address:
79355 CAMINO ROSADO, La Quinta CA 92253
Enforcement Agency:
City of La Quinta
Permit Number:
1 13-829 11
Minimum Airflow Reauirement
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
1
Calculate: Actual Temperature Split = Treturn,
db - Tsupply, db
Target Temperature Split from Table RA3.2-3
using Treturn 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 -4°F and
-100°F
Enter Pass or Fail
Note: Temperature Split Methd.dtalculation 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 measurthe value must be equal to or greater than the Calculated
Minimum Airflow Requirementsin. the table below.
-.S-✓ ,.,-nk"
Calculatewminimum Airflow Requirement (CFM) y Nom1nat Co�ohng°Capacity (ton) X3o 0
k
(dm/ton),
Systername or de, tific,ag
•l:'a`. �ti, t�i 4i��. . 1k.. -rY.
> �
�+. , .lYk k., ".
.fY1w .';s.:
d ./
Calculated Mmimum`AirFlow Re' uwrernent
Measured Airflow using RA3.3xpebcedures
(CFM)'',
Measurement Method
Passes if measured airflow is greater than or
equal to the calculated minimum airflow
requirement.
Enter Pass or Fail
Reg:'213-A0049048A-M2500001A-M25A Registration Date/Time: 2013/07/20 20:54:48 HERS Provicler: Ca1CBRTS, Inc.
2008 Residential Compliance Forms I February 2013
I I r
INSTALLATION CERTIFICATE CF-4R-MECH-2S
Refrigerant Charge Verification - Standard Measurement Procedure (Page S of 6)
Site Address: Enforcement Agency: Permit Number:
79355 CAMINO ROSADO, La Quinta CA 92253 City of La Quinta 1 13-829
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
systems.
System Name or Identificationag
Calculate: Actual Superheat =
Tsuction - Teva orator sat
x
x
e ,k'v.j '�• \'may
Target Superheat from Table RA3.2-2 using
Tsuction - Teva orator sat
z'iY ��✓&`' '+y
���
Treturn wb and Tcondenser, db
� �1T.T"b S �
.�..
Calculate difference:
h ti 1
4w
- '
Actual Superheat - Target Superheat =
between 3°F and 26°F if manufacturer's
System passes if difference is between -6°F
W1
RIA
specification is not available)
and +6°F
'��
System passes if actual superheat is within.
-W
Enter Pass or Fail
� LA
the allowable superheat range
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
systems.
System Name or Identificationag
Calculate: Actual Subcooling
Tcondenser -sat - T.li" uid
x
x
e ,k'v.j '�• \'may
Target'Subcooling specified by manufacturer
Tsuction - Teva orator sat
z'iY ��✓&`' '+y
���
� F
� �1T.T"b S �
.�..
Calculate difference ,
SuE?coolrngTa..
rget
h ti 1
4w
- '
Actual Subcoolig-, ,
between 3°F and 26°F if manufacturer's
..
if differ riceis�tween
-4°Fand44FF 4$
�Lii
W1
RIA
specification is not available)
�, Enter,�Pass4or Fail
'��
System passes if actual superheat is within.
-W
. � �
� LA
the allowable superheat range
Metering Device,Calculationifo.nyvalve k - Refrigerant Charge Verification. This
procedure is required to be
used for:fhermostatic expansio(TXV) and electronic expansion valve (EXV)
systems.
System Name or Identificationag
x
x
e ,k'v.j '�• \'may
h�KS'Tv y'�i
_
Tsuction - Teva orator sat
z'iY ��✓&`' '+y
���
� F
� �1T.T"b S �
.�..
Metering Device,Calculationifo.nyvalve k - Refrigerant Charge Verification. This
procedure is required to be
used for:fhermostatic expansio(TXV) and electronic expansion valve (EXV)
systems.
System Name or Identificationag
Calculate: Actual Superheat; =r"
Tsuction - Teva orator sat
Enter allowable superheat range from
manufacturer's specifications (or use range
between 3°F and 26°F if manufacturer's
specification is not available)
System passes if actual superheat is within.
the allowable superheat range
Enter Pass or Fail
Reg: 213-A0049048A-M2500001A-M25A Registration Date/Time: 2013/07/20 20:54:48 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms February 2013
INSTALLATION CERTIFICATE CF-4R-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page 6 of 6)
Site Address: Enforcement Agency: Permit Number:
79355 CAMINO ROSADO, La Quinta CA 92253 City of La Quinta 13-829
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
686310 ;
HERS Provider Data Registry Information
Sam ple.Group # (if applicable): 431295
System meets all refrigerant charge and
® not-tested/verified dwelling
lin
1
a HERS sample group
airflow requirements.
HERS Rater Company Name:
Stratz Permit Service
Responsible Rater's Name:
Responsible Rater's Signature:
Enter Pass or Fail
Patrick Schlosser
Responsible Rater's Certification Number w/ this HERS
Date Signed: 7/8/2013
Provider:
❑ Residential Appendix RA3.2.2 requires that if the outdoor temperature is between 55°F and 65°F the
return air dry bulb temperature shall be maintained above 70°F during the Standard Charge Measurement
Procedure. The signature of the Responsible Person in the declaration statement below certifies this
requirement has been met for all applicable system verifications reported on this certificate.
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) respon ble for the instaliption _conforms to;the-requirements specified "on-the-Certificate(9)xQf Compliance
(CF-1R).aooroved%v the enforce ent,aaencv: ) ��` , -: 1 it,
Builderibr Installer inf_ornp.ation as.sh"own on,rtlte':InstallationdGertificate (CF=6RN- s -. -
Company Name: (Insstallmg Subcontractor or Gen'eral.-Contractor or Builder/Owner`° •,) 5 ,777
HARRISON ENT�ERPRISE'S tINC ,r
Responsible Person's Name .,„" "-
CSLB'License
Danielle Garcia ".
686310 ;
HERS Provider Data Registry Information
Sam ple.Group # (if applicable): 431295
❑ tested/verified dwelling
® not-tested/verified dwelling
lin
1
a HERS sample group
HERS Rater Information CaICERTS Certificate # CC1-1798771878
HERS Rater Company Name:
Stratz Permit Service
Responsible Rater's Name:
Responsible Rater's Signature:
Patrick Schlosser
Patrick Schlosser
Responsible Rater's Certification Number w/ this HERS
Date Signed: 7/8/2013
Provider:
CC2005727
IN
Reg: 213-A0049048A-M2500001A-M25A Registration Date/Time: 2013/07/20 20:54:48 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms February 2013